Clinical and bone density outcomes of tumor-induced osteomalacia after treatment.

Abstract

OBJECTIVE:

To report the outcomes of tumor-induced osteomalacia after treatment, particularly related to recovery of bone mass.

METHODS:

We review the clinical course of a 61-year-old man extremely debilitated from multiple fractures and neuromuscular weakness due to tumor-induced osteomalacia and report the changes in biochemical markers and bone density after removal of the causative neoplasm.

RESULTS:

At the time of diagnosis, the patient's serum phosphorus and 1,25 dihydroxyvitamin D levels were depressed, and his fibroblast growth factor-23 level was markedly elevated. These values normalized 2 days after surgery and remained within their respective reference ranges 4 and 12 months after resection of a mesenchymal tumor. Lumbar bone density values (T-scores) were 0.445 g/cm2 (-5.9) preoperatively, 0.939 g/cm2 (-1.4) 4 months after surgery, and 1.152 g/cm2 (0.7) 12 months after surgery. Left femoral neck values at the same time points were 0.525 g/cm2 (-3.0), 1.035 g/cm2 (-0.8), and 1.184 g/cm2 (1.9). Ultra-distal radius values at the same time points were 0.128 g/cm2 (-7.0), 0.191 g/cm2 (-5.9), and 0.259 g/cm2 (-4.8). In addition, he recovered neuromuscular function and was able to leave his wheelchair.

CONCLUSION:

Tumor-induced osteomalacia can be an extremely debilitating disease. With successful localization, identification, and resection of the neoplasm, bone mass and physical function can recover.

• Authors: Lisa G Umphrey, Michael D Whitaker, E Peter Bosch, Curtiss B Cook
• Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (Endocr Pract) Vol. 13 Issue 5 Pg. 458-62 (Sep 2007) ISSN: 1934-2403 [Electronic] United States
• PMID: 17872346 (Publication Type: Case Reports, Journal Article)

Chemical References

• Fibroblast Growth Factors
• Fibroblast Growth Factor-23

Topics

• Bone Density
• Disability Evaluation
• Fibroblast Growth Factor-23
• Fibroblast Growth Factors (blood, metabolism)
• Fractures, Compression (diagnostic imaging, etiology)
• Humans
• Magnetic Resonance Imaging
• Male
• Mesenchymoma (complications, diagnosis, surgery)
• Middle Aged
• Mixed Tumor, Malignant (complications, diagnosis, surgery)
• Muscle Weakness (etiology)
• Osteomalacia (diagnostic imaging, etiology)
• Paraneoplastic Syndromes (diagnostic imaging, etiology)
• Positron-Emission Tomography
• Radiography
• Recovery of Function
• Soft Tissue Neoplasms (complications, diagnosis, surgery)