Adult-onset hypophosphatemic osteomalacia as a cause of widespread musculoskeletal pain: A retrospective case series of single center experience.

Autor:	Kim S; Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea., Kim SW; Department of Physical and Rehabilitation Medicine, Jungdap Hospital, Suwon 16480, South Korea., Lee BC; Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Seoul 06973, South Korea., Kim DH; Physical Medicine and Rehabilitation, Chung-Ang University, Seoul 06973, South Korea., Sung DH; Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Seoul 06351, South Korea. yays.sung@samsung.com.
Jazyk:	angličtina
Zdroj:	World journal of clinical cases [World J Clin Cases] 2023 Nov 16; Vol. 11 (32), pp. 7785-7794.
DOI:	10.12998/wjcc.v11.i32.7785
Abstrakt:	Background: Osteomalacia (OM) is frequently confused with various musculoskeletal or other rheumatic diseases, especially in patients with adult-onset widespread musculoskeletal pain because of its low prevalence and non-specific manifestations. Aim: To facilitate the early diagnosis and etiology-specific treatment of adult-onset hypophosphatemic OM. Methods: A retrospective review of medical records was performed to screen adult patients who visited a physiatry locomotive medicine clinic (spine and musculoskeletal pain clinic) primarily presenting with widespread musculoskeletal pain at a single tertiary hospital between January 2011 and December 2019. We enrolled patients with hypophosphatemia, high serum bone-specific alkaline phosphatase levels, and at least one imaging finding suggestive of OM. Results: Eight patients with adult-onset hypophosphatemic OM were included. The back was the most common site of pain. Proximal dominant symmetric muscle weakness was observed in more than half of the patients. Bone scintigraphy was the most useful imaging modality for diagnosing OM because radiotracer uptake in OM showed characteristic patterns. Six patients were diagnosed with adefovir (ADV)-induced Fanconi syndrome, and the other two patients were diagnosed with tumor-induced OM and light-chain nephropathy, respectively. After phosphorus and vitamin D supplementation and treatment for the underlying etiologies, improvements in pain, muscle strength, and gait were observed in all patients. Conclusion: Mechanical pain characteristics, hypophosphatemia, and distinctive bone scintigraphy patterns are the initial diagnostic indicators of adult-onset hypophosphatemic OM. ADV-induced Fanconi syndrome is the most common etiology of hypophosphatemic OM in hepatitis B virus-endemic countries. Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
Databáze:	MEDLINE
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