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Clinical characteristics of pediatric tumor-induced osteomalacia: a systematic review and individual patient data
Rong Chen1, Zhangxin Wen2, Cheng Cheng1,3
1Department of Osteoporosis, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Insights
Pediatric tumor-induced osteomalacia (TIO) is more common in males and often misdiagnosed. Surgical removal of benign tumors, typically in the lower extremities, is the preferred treatment for this condition.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Metabolic Bone Disease
Background:
- Pediatric tumor-induced osteomalacia (TIO), also known as tumor-induced rickets (TIR), is a rare condition.
- It is characterized by renal phosphate wasting leading to hypophosphatemia and rickets in children.
Purpose of the Study:
- To evaluate the clinical characteristics of pediatric TIO patients.
- To identify key features for diagnosis and treatment of TIO in children.
Main Methods:
- Systematic literature search conducted in major databases (PubMed, Elsevier, SpringerLink, CNKI, Wanfang Data).
- Inclusion of studies in English and Chinese, adhering to PRISMA criteria.
- Analysis of 62 pediatric TIO cases.
Main Results:
- Pediatric TIO is more prevalent in males, with higher rates of weakness and deformities.
- A significant percentage (16.1%) of patients were initially misdiagnosed.
- Tumors causing TIO were predominantly benign, located in the lower extremities, and identifiable with somatostatin receptor imaging.
Conclusions:
- Pediatric TIO presents with distinct characteristics in males and is prone to misdiagnosis.
- Benign neoplasms in the lower extremities are common causes.
- Surgery offers high resolution rates, and TIO should be considered in pediatric hypophosphatemia cases.
Purpose:
Pediatric tumor-induced osteomalacia (TIO), also called Tumor-induced rickets (TIR), is characterized by renal phosphate wasting, resulting in hypophosphatemia and rickets. This study aimed to evaluate the clinical characteristics of pediatric TIO patients.
Methods:
A systematic search was performed on December 26, 2025, in PubMed, Elsevier, SpringerLink, the China National Knowledge Infrastructure, and Wanfang Data using the terms: "tumor-induced rickets," "tumor-induced hypophosphatemic rickets," "oncogenic osteomalacia," "hypophosphatemia," "tumor-induced osteomalacia," "children," "child," and "pediatrics". Studies published in English and Chinese were included. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.
Results:
A total of 62 pediatric TIO cases were included. Pediatric TIO was more frequent in males, who exhibited a higher proportion of weakness and deformities compared with females. 16.1% of patients were misdiagnosed with another condition. Somatostatin receptor-based imaging modalities demonstrated a high proportion for identifying these tumors. Pediatric TIO-causing neoplasms were predominantly located in the lower extremities and primarily originated from the bone tissue. Benign tumors were more common than malignant ones. The latter were associated with lower serum calcium levels. Surgery is the preferred definitive treatment for pediatric TIO, with an 84.2% resolution proportion.
Conclusion:
Pediatric TIO affects males more frequently than females, with male patients exhibiting a higher proportion of weakness and deformities, and is prone to misdiagnosis. Neoplasms are mostly located in the lower extremities and are predominantly benign. Surgery is the preferred treatment for pediatric TIO. For hypophosphatemic pediatric patients, TIO should be considered to preventing adverse outcomes.
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