Related Experiment Video
Updated: Oct 11, 2025
The Caco-2 Cell Bioassay for Measurement of Food Iron Bioavailability
Published on: April 28, 2022
[Osteomalacia following intravenous iron suppletion]
Natasja Koks1,2, Esther Donga3, Natasha M Appelman-Dijkstra4
1Erasmus MC, afd. Interne Geneeskunde, Rotterdam.
Background:
Ferric carboxymaltose (FCM) is highly effective in supplementing iron-deficiency anemia and frequently used. However, it can severely interfere with the phosphate metabolism.
Case Description:
A 63 year old man with iron-deficiency anemia due to hereditary hemorrhagic telangiectasia was treated with intravenous FCM. After initiation of the FCM he developed generalized bone and muscle pain as well as insufficiency fractures. Treatment with colecalciferol was started. However, the bone pain increased and further investigation showed a hypophosphatemicosteomalacia with high urine phosphate loss suggesting renal phosphate wasting. Serum FGF23 level was increased confirming the diagnosis of FGF23 mediated hypophosphatemicosteomalacia induced by intravenous iron suppletion.
Conclusion:
FCM injections may cause FGF23 mediated hypophosphatemia already 4 weeks after suppletion. Therefore it is recommended that serum phosphate levels should be checked frequently. In patients developing hypophosphatemia, a non-maltose form of iron suppletion must be started as well as active vitamin D.
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