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Hypophosphataemic osteomalacia: case report A 65-year-old man developed hypophosphataemic osteomalacia during treatment with ferric-carboxymaltose for iron deficiency anaemia. The man was hospitalised with widespread pain, which he had been suffering from the last 6 months before admission. He had increasing bone pain in pelvic girdle, four limbs and both shoulders, which worsened with movements. He required wheelchair and crutch for movement. His medical hostory included type 2 diabetes and osteoporosis. He had been receiving multiple drugs. He had been treated with oral ferrous-sulfate [ferrous sulphate] for 15 years, but he required monthly IV iron treatment with ferriccarboxymaltose [dosage not stated] in the last 2 years for iron deficiency anaemia. He also had gastric and duodenal angiodysplasia, which was treated by ligation with elastic bands. He was diagnosed of osteoporosis and a mild vertebral fracture before 3 years. He was treated with risedronic-acid [risedronate], calcium and colecalciferol [vitamin D] since then with good adherence. Physical examination revealed that he had several facial and oral angiodysplasias and tenderness on both shoulders, knees and femurs. Laboratory tests showed phosphate 1.2 mg/L, calcium 9.2 mg/dL, alkaline phosphatase (ALP) 356 U/L, 25-hydroxyvitamin D 21.8 ng/mL, creatinine 0.93 mg/dL, 24-hour urine calcium 46.8mg, parathyroid hormone (PTH) 82 pg/mL, phosphate 0.44g, fractional excretion of phosphate (FEPO4) was 5.9%, and serum C-terminal FGF-23 was greater than 419 RU/mL. Bone scan findings were suspicious of insufficiency fractures or Looser’s zones. Whole-body CT and MRI excluded metastasis and confirmed multiple insufficiency fractures. A significant loss of bone mineral density (BMD) was noted. Based on the investigational findings, diagnosis of FGF-23-mediated hypophosphatemic osteomalacia probably induced by ferric-carboxymaltose was confirmed. The man was treated with sodium phosphate, calcium and colecalciferol. Treatment with risedronic-acid was discontinued. Treatment with ferric-carboxymaltose was switched to iron sucrose. During follow-up period, his pain and mobility improved gradually. Callejas-Moraga EL, et al. Severe osteomalacia with multiple insufficiency fractures secondary to intravenous iron therapy in a patient with Rendu-Osler-Weber syndrome. 803502948 Bone Reports 13: 100712, Dec 2020. Available from: URL: http://doi.org/10.1016/j.bonr.2020.100712

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Reactions 26 Sep 2020 No. 1823