{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T14:21:03Z","timestamp":1793370063758,"version":"4.5.0"},"reference-count":119,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T00:00:00Z","timestamp":1670889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Tumor\u2010induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by mesenchymal tumors that secrete fibroblast growth factor 23 (FGF23). Patients present with progressive bone pain, muscle weakness, and fragility fractures. TIO is characterized by hypophosphatemia, excess renal phosphate excretion, and low\/inappropriately normal 1,25\u2010dihydroxyvitamin D (1,25(OH)\n                    <jats:sub>2<\/jats:sub>\n                    D) levels. Rarity and enigmatic clinical presentation of TIO contribute to limited awareness among the medical community. Accordingly, appropriate diagnostic tests may not be requested, leading to delayed diagnosis and poorer patient outcomes. We have developed a global guidance document to improve the knowledge of TIO in the medical community, enabling the recognition of patients with TIO and appropriate referral. We provide recommendations aiding diagnosis, referral, and treatment, helping promote a global standard of patient management. We reviewed the literature and conducted a three\u2010round Delphi survey of TIO experts. Statements were drafted based on published evidence and expert opinions (\u226570% consensus required for final recommendations). Serum phosphate should be measured in patients presenting with chronic muscle pain or weakness, fragility fractures, or bone pain. Physical examination should establish features of myopathy and identify masses that could be causative tumors. Priority laboratory evaluations should include urine\/serum phosphate and creatinine to assess renal tubular reabsorption of phosphate and TmP\/GFR, alkaline phosphatase, parathyroid hormone, 25\u2010hydroxyvitamin D, 1,25(OH)\n                    <jats:sub>2<\/jats:sub>\n                    D, and FGF23. Patients with the clinical\/biochemical suspicion of TIO should be referred to a specialist for diagnosis confirmation, and functional imaging should be used to localize causative tumor(s). Recommended treatment is tumor resection or, with unresectable\/unidentifiable tumors, phosphate salts plus active vitamin D, or burosumab.\n                  <\/jats:p>","DOI":"10.1111\/joim.13593","type":"journal-article","created":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T08:44:52Z","timestamp":1670921092000},"page":"309-328","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":105,"title":["Global guidance for the recognition, diagnosis, and management of tumor\u2010induced osteomalacia"],"prefix":"10.1111","volume":"293","author":[{"given":"Suzanne M.","family":"Jan de Beur","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Minisola","sequence":"additional","affiliation":[{"name":"Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences Sapienza University  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei\u2010bo","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Key Laboratory of Endocrinology State Key Laboratory of Complex Severe and Rare Diseases NHC Peking Union Medical College Hospital Chinese Academy of Medical Science and Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Abrahamsen","sequence":"additional","affiliation":[{"name":"Open Patient data Explorative Network (OPEN) Department of Clinical Research University of Southern Denmark and Odense University Hospital  Odense Denmark"},{"name":"Department of Medicine Holb\u00e6k Hospital  Holb\u00e6k Denmark"},{"name":"Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Jacques","family":"Body","sequence":"additional","affiliation":[{"name":"Department of Medicine CHU Brugmann Universit\u00e9 Libre de Bruxelles  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa","family":"Brandi","sequence":"additional","affiliation":[{"name":"Department of Surgery and Translational Medicine University of Florence University Hospital of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roderick","family":"Clifton\u2010Bligh","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Royal North Shore Hospital  Sydney Australia"},{"name":"Cancer Genetics Unit Kolling Institute  Sydney Australia"},{"name":"Sydney Medical School University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Collins","sequence":"additional","affiliation":[{"name":"Skeletal Diseases and Mineral Homeostasis Section National Institute of Dental and Craniofacial Research National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Florenzano","sequence":"additional","affiliation":[{"name":"Centro Traslacional de Endocrinolog\u00eda UC (CETREN\u2010UC) Endocrinology Department School of Medicine Pontificia Universidad Cat\u00f3lica de Chile  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Houillier","sequence":"additional","affiliation":[{"name":"Centre de Recherche des Cordeliers INSERM Sorbonne Universit\u00e9 Universit\u00e9 de Paris D\u00e9partement des Maladies R\u00e9nales et M\u00e9taboliques H\u00f4pital Europ\u00e9en Georges\u2010Pompidou Assistance Publique\u2010H\u00f4pitaux de Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuo","family":"Imanishi","sequence":"additional","affiliation":[{"name":"Department of Metabolism, Endocrinology, and Molecular Medicine Osaka Metropolitan University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik A.","family":"Imel","sequence":"additional","affiliation":[{"name":"Division of Endocrinology Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliya A.","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism Calcium Disorders Clinic Department of Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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