Adefovir Dipovoxil Induced Hypophosphatemia Osteomalacia With Multiple Fracture And Literature Review

Objective:To study about the clinical manifestation of adefovir dipivoxil induced hypophosphatemia osteomalacia for the purpose of early diagnosed and proper treatment.Method:Review the clinical history,laboratory examination,radiology examination,therapeutic method and effect of 2 patients with adefovir dipivoxil induced hypophosphatemia osteomalacia who hospitalized in the second affiliated Hospital of Zhejiang University in 2015 and 2017.Result:The 2 patients take adefovir dipivoxil as antiviral therapy for more than 8 years,and both of them presented with bone pain and activity disturbance.Laboratory examination is characterized with hypophosphatemia,elevation of alkaline phosphatase and hypouricemia.Urine examination showed increased excretion of phosphorus,glucose,protein and uric acid.Bone mineral density showed osteopenia.Hypophosphatemia osteomalacia is diagnosed with the history and examination.Treated with replacement of the antiviral drugs,supplement of phophrus,active vitamin D and calcium,the patients’ bone pain gradually released and the level of phosphorus rose to normal level.Conclusion:Prolonged low dose Adefovir Dipovoxil therapy in hepatitis B virus patients will lead to Fanconi’s Syndrome and hypophosphatemia osteomalacia.Patients who take adefovir dipivoxil chronically should regularly monitor the level of phosphorus.Bone pain and fatigue should be noted.