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

作　　者：Sungwon Kim Sun Woong Kim Byung Chan Lee Du Hwan Kim Duk Hyun Sung 

机构地区：[1]Department of Physical and Rehabilitation Medicine,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul 06351,South Korea [2]Department of Physical and Rehabilitation Medicine,Jungdap Hospital,Suwon 16480,South Korea [3]Physical Medicine and Rehabilitation,Chung-Ang University Hospital,Seoul 06973,South Korea [4]Physical Medicine and Rehabilitation,Chung-Ang University,Seoul 06973,South Korea [5]Department of Physical and Rehabilitation Medicine,Samsung Medical Center,Seoul 06351,South Korea

出　　处：《World Journal of Clinical Cases》2023年第32期7785-7794,共10页世界临床病例杂志

基　　金：This study was approved by the Institutional Review Board of Samsung Medical Center(approval number:2020-09-027-001).

摘　　要：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.

关 键 词：HYPOPHOSPHATEMIA OSTEOMALACIA Widespread musculoskeletal pain Bone scintigraphy Hepatitis B virus Phosphaturic mesenchymal tumor 

分 类 号：R733[医药卫生—肿瘤] R681[医药卫生—临床医学] R445.2