Clinical Analysis Of Tumor-Induced Osteomalacia

Objective: To analyze the clinical characteristics of tumor-induced osteomalacia.Methods: Data of seven tumor-induced osteomalacia patients were retrospectively analyzed,including medical history,physical examination,bone metabolism markers,bone mineral density,imaging examination such as X-ray,CT,MRI or PET-CT,and pathological results.Blood phosphorus levers before and after surgey were observed.Results:1 In our study,7 patients were studied,4 males and 3 females,with an average age of 46.1±10.6 years,The disease duration was 6.1±4.3years,The mean age of onset was 40.0±11.3years.2 Clinical features: All these patients had bone pain and walked difficultly.Six patients(85.7%)were obvious weak,and five patients(71.4%)were shorter than before,the range of differences was from five centimeters to fourteen centimeters.Five patients(71.4%)had bone deformity,mainly in thoracolumbar vertebra and hip.3 Biochemical results: The level of serum phosphorus was0.41±0.12mmol/L,blood calcium was 2.24±0.11mmol/L,blood ALP was247.14±129.40U/L,PTH was 76.93±31.76pg/ml,24 hUp was 11.31±5.33 mmol/ml,25(OH)D was 15.38±7.26ng/ml,?-ctx was 0.62±0.42ng/ml,P1 NP was 62.24±36.71ng/ml,and OC was 17.56 ±8.95ng/ml.4 Imaging examination: Osteomalacia such as osteoporosis,bone malformation could be seen in these X-ray films.Six(85.7%)patients had multiple fractures.Bone mineral density(BMD)was significantly decreased in all patients.The location of tumor was found by PET-CT,enhanced CT or MRI.Tumors were mostly found in the limbs and head(71.4%).5 Treatment and prognosis: Surgical resection of the tumor was performed in all patients,and the pathological type was phosphaturic mesenchymal tumor(PMT).Four cases(57.2%)occurred in bone tissue,while three in the soft tissue(42.8%).Five days after surgery,the patient's blood phosphorus level was 1.02±0.06mmol/L,which was significantly higher than that before the operation(P < 0.001),and one month later the blood phosphorus was 1.23±0.19mmol/L.The symptoms of bone pain,fatigue and difficulty in walking were significantly improved.Conclusion: TIO patients had clinical manifestations such as progressive aggravation of bone pain,fatigue,height loss,and multiple fracture.And typical biochemical results were low serum phosphorus and increased urinary phosphorus excretion.Multiple methods were needed tolocate the tumor.And after complete surgical resection of the tumor,patients' s condition were improved obviously.