{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:36:36Z","timestamp":1793039796617,"version":"4.5.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T00:00:00Z","timestamp":1641513600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["T32GM007347"],"award-info":[{"award-number":["T32GM007347"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asbmr.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JBMR Plus"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Tumor\u2010induced osteomalacia (TIO) is a rare paraneoplastic disease characterized by frequent fractures, bone pain, muscle weakness, and affected gait. The rarity of TIO and similar presentation to other phosphate\u2010wasting disorders contribute to a high misdiagnosis rate and long time to correct diagnosis. TIO is curable by tumor resection, so accurate diagnosis has significant impact on patients' emotional and economic burden. Current diagnostics for TIO rely on decades\u2010old literature with poor phenotypic validation. Here, we identify salient clinical differences between rigorously validated cohorts of patients with TIO (\n                    <jats:italic>n<\/jats:italic>\n                    \u00a0=\u00a09) and X\u2010linked hypophosphatemia (XLH;\n                    <jats:italic>n<\/jats:italic>\n                    \u00a0=\u00a043), a frequent misdiagnosis for patients with TIO. The TIO cohort had significantly elevated FGF23 (365 versus 95 RU\/mL,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and alkaline phosphatase (282.8 versus 118.5\u00a0IU\/L,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01) but significantly reduced phosphorus (1.4 versus 2.2\u00a0mg\/dL,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05) and 1,25(OH)\n                    <jats:sub>2<\/jats:sub>\n                    D (16.6 versus 59.8\u00a0pg\/mL,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). By contrast, total vitamin D was similar between the two groups. Dual\u2010energy X\u2010ray absorptiometry (DXA) scans reveal lower\n                    <jats:italic>Z<\/jats:italic>\n                    \u2010scores in the hip (\u22121.6 versus 0.050,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01) and spine (0.80 versus 2.35,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). TIO patients were more likely to have prior clinical diagnosis of osteoporosis (67% versus 0%), use assistive devices in daily living (100% versus 14%), and have received a knee arthroplasty (33% versus 7%). TIO patients lost an average of 1.5\u00a0cm over their disease course and had sustained an average of 8 fractures each, whereas fractures were rare in XLH. The XLH cohort had higher incidence of osteotomy (19% versus 0%), spinal stenosis (12% versus 0%), secondary dental abnormalities (95% versus 44%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), and depression and anxiety (46.5% versus 11%). These results deepen our understanding of the subtle differences present between diseases of phosphate wasting. They suggest several biochemical, clinical, and historical features that effectively distinguish TIO from XLH. \u00a9 2022 The Authors.\n                    <jats:italic>JBMR Plus<\/jats:italic>\n                    published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.\n                  <\/jats:p>","DOI":"10.1002\/jbm4.10580","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T04:24:39Z","timestamp":1636345479000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Rare Diseases That Impersonate One Another:\n                    <scp>X\u2010Linked<\/scp>\n                    Hypophosphatemia and\n                    <scp>Tumor\u2010Induced<\/scp>\n                    Osteomalacia, a Retrospective Analysis of Discriminating Features"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0131-6176","authenticated-orcid":false,"given":"Joseph","family":"DeCorte","sequence":"first","affiliation":[{"name":"Vanderbilt Medical Scientist Training Program Vanderbilt University Medical Center, Vanderbilt University School of Medicine Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9763-0740","authenticated-orcid":false,"given":"Ericka","family":"Randazzo","sequence":"additional","affiliation":[{"name":"Vanderbilt Medical Scientist Training Program Vanderbilt University Medical Center, Vanderbilt University School of Medicine Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2152-6522","authenticated-orcid":false,"given":"Margo","family":"Black","sequence":"additional","affiliation":[{"name":"Program for Metabolic Bone Disorders at Vanderbilt, Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine Vanderbilt University Medical Center Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2600-9655","authenticated-orcid":false,"given":"Chase","family":"Hendrickson","sequence":"additional","affiliation":[{"name":"Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine Vanderbilt University Medical Center Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9980-9138","authenticated-orcid":false,"given":"Kathryn","family":"Dahir","sequence":"additional","affiliation":[{"name":"Program for Metabolic Bone Disorders at Vanderbilt, Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine Vanderbilt University Medical Center Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,1,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-0887-1_4"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.30599"},{"issue":"4","key":"e_1_2_8_4_1","first-page":"434","article-title":"Fibrous dysplasia, phosphate wasting and fibroblast growth factor 23","volume":"4","author":"Imel EA","year":"2007","journal-title":"Pediatr Endocrinol 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