Ferric-carboxymaltose

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Multiple fractures and severe hypophosphataemic osteomalacia: 3 case reports In an observational descriptive study, 3 patients including a woman [not all sexes stated] aged 36–75 years, were described, who developed multiple fractures and severe hypophosphataemic osteomalacia (HPO) during treatment with ferric carboxymaltose for anaemia [dosages, routes and time to reactions onset not stated]. Case 1: The 36-year-old patient, who had anaemia, started receiving treatment with ferric carboxymaltose from Oct 2010. Subsequently, the patient developed severe HPO and multiple fractures including left calcaneus posterior tuberosity, astragaline dome, right femoral head, left talus, tibial pylon, tibia-astragaline, ischiopubic branch, right second metatarsal, distal tibia and posterior tuberosity of the calcaneus. Laboratory investigation showed bone densitometry of lumbar spine and femoral neck were -2.4 (Z-score), decreased phosphate level, the parathyroid hormone was 71 pg/mL, urine phosphate excretion was 1609 mg/24 hours and tubular phosphate reabsorption was 58.3%. The fibroblast growth factor (FGF)-23 was 183 kRU/L. In Oct 2018, the patient’s treatment with ferric-carboxymaltose was discontinued. Ten months after the discontinuation of treatment, the patients condition had normalised, and no fractures were observed thereafter. Case 2: The 75-year-old patient, who had anaemia, started receiving treatment with ferric carboxymaltose from Aug 2013. Subsequently, the patient developed severe HPO and fractures of both femoral necks and right sacral wing. Laboratory investigation showed decreased phosphate level, calcium level was 8.3 mg/dL, parathyroid hormone level was 223 pg/mL, alkaline phosphatase was 140 IU/L, urine phosphate excretion was 1630 mg/24 hours and tubular phosphate reabsorption was 50.2%. The fibroblast growth factor (FGF)-23 was 335 kRU/L. In Nov 2018, the patient’s treatment with ferric-carboxymaltose was discontinued. Four months after the discontinuation of treatment, the patients condition had normalised, and no fractures were observed thereafter. Case 3: A 43-year-old woman, who had anaemia, started receiving treatment with ferric carboxymaltose from Feb 2018. Subsequently, she developed severe HPO and fractures of both femoral heads. Laboratory investigation showed bone densitometry of the lumbar spine and femoral neck were -0.5 and -1.3 (Z-score), respectively. Her phosphate level was decreased, the parathyroid hormone was 104 pg/mL, tubular phosphate reabsorption was 70.7% and fibroblast growth factor (FGF)-23 was 201 kRU/L. In Jun 2018, her treatment with ferric-carboxymaltose was discontinued. Eight months after the discontinuation of treatment, her condition had normalised, and no fractures were observed thereafter. Fernandez E, et al. Multiple fractures due to iron-induced and FGF23-mediated hypophosphataemic osteomalacia: an unknown adverse effect. Annals of the Rheumatic 803517096 Diseases 79 (Suppl.): 1763 abstr. AB0925, Jun 2020. Available from: URL: https://ard.bmj.com/content/79/S

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