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Published on: June 23, 2015
Adult onset idiopathic phosphate diabetes
Summary
Idiopathic phosphorus diabetes (IPD) is a rheumatic condition causing chronic pain, fatigue, and depression. Early diagnosis, often missed, is key, as treatment with calcitriol and phosphorus can improve bone density and symptoms.
Area of Science:
- Rheumatology
- Endocrinology
- Nephrology
Background:
- Idiopathic Phosphorus Diabetes (IPD) is characterized by low serum phosphate and decreased renal tubular reabsorption of phosphate.
- It presents with chronic pain, fatigue, and depression, often misdiagnosed due to uncalculated maximal phosphate reabsorption rates.
Purpose of the Study:
- To describe the clinical, biological, and bone density data of adults with IPD.
- To highlight the association of IPD with hypercalciuria and osteoporosis.
- To evaluate the potential improvement of symptoms and bone mineral density with treatment.
Main Methods:
- Retrospective analysis of 19 adult patients diagnosed with IPD in a rheumatology department.
- Clinical data collection including symptoms, biochemical tests (serum phosphate, tubular reabsorption of phosphate), and bone mineral density (BMD) measurements.
- Bone biopsy in a subset of patients.
Main Results:
- 19 patients (14 males, 5 females) diagnosed with IPD, with mean age at onset 36.7 years.
- Common symptoms included axial pain (90%), nocturnal pain (74%), radicular pain (68%), depression (53%), and fractures (32%).
- Low bone mineral density (L2-L4 Z-score: -2.13, femoral neck: -1.34) and osteoporosis were observed. Hypercalciuria was present in 47% of patients.
Conclusions:
- IPD is a rheumatic disease associated with significant pain, fatigue, and depression, and is often underdiagnosed.
- Patients exhibit reduced bone mineral density and osteoporosis, with a notable incidence of hypercalciuria.
- Treatment with oral calcitriol and phosphorus may improve bone density and clinical symptoms, though improvement may be delayed.
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