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Iatrogenic osteomalacia: report of two cases

Sunao Yamamoto1, Yosuke Okada, Hiroko Mori

  • 1First Department of Internal Medicine, University of Occupational and Environmental Health, Japan.

Journal of UOEH
|March 12, 2013
PubMed
Abstract

Insights

Iatrogenic causes, such as saccharated ferric oxide and total gastrectomy, can lead to osteomalacia. Early identification and intervention are crucial for managing pain and bone health in these patients.

Area of Science:

  • Endocrinology
  • Nephrology
  • Gastroenterology

Background:

  • Osteomalacia can present with unexplained bone pain, necessitating a thorough investigation into potential iatrogenic causes.
  • Iron-deficiency anemia and gastric cancer surgery are clinical scenarios that may predispose patients to specific types of osteomalacia.

Observation:

  • Case 1: An 80-year-old male with a history of intravenous saccharated ferric oxide (SFO) administration developed hypophosphatemia and elevated fibroblast growth factor 23 (FGF23), indicative of FGF23-related osteomalacia.
  • Case 2: A 63-year-old female, post-total gastrectomy, presented with hypocalcemia, hypophosphatemia, and vitamin D deficiency, consistent with vitamin D-deficient osteomalacia due to impaired absorption.

Findings:

  • Discontinuation of SFO in Case 1 resulted in pain relief and normalization of phosphorus and FGF23 levels within one month.
  • Treatment with oral alfacalcidol in Case 2 led to pain improvement over two months, suggesting successful management of vitamin D-deficient osteomalacia.

Implications:

  • These cases highlight the importance of considering iatrogenic etiologies, particularly medication side effects and surgical history, in the differential diagnosis of unexplained osteomalacia.
  • Prompt diagnosis and appropriate management, including drug withdrawal or supplementation, are essential for improving patient outcomes and preventing long-term skeletal complications.

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