{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T14:54:11Z","timestamp":1773154451430,"version":"3.50.1"},"reference-count":20,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>A teenage boy with vertically acquired-HIV presented with bone pain of 6\u2005months duration. His antiretroviral therapy (ART) consisted of tenofovir disoproxil fumarate (TDF), emtricitabine and ritonavir-boosted lopinavir. Plain X-rays showed stress fractures of metatarsals bilaterally. A dual emission X-ray absorptiometry scan revealed osteomalacia. Raised serum creatine, hypophosphataemia, glycosuria and metabolic acidosis supported a diagnosis of Fanconi's syndrome. Serum vitamin D levels were low. Discontinuation of TDF led to improvement in renal function, increase in serum phosphate and resolution of bone pain. This case uniquely features renal and skeletal toxicities with resultant metatarsal stress fractures. Children and adolescents on combined ART which include tenofovir should be screened for the early detection of proximal tubulopathy, with the measurement of renal function, phosphate, vitamin D and urinary phosphate excretion. Although uncommon and mostly reversible, recognition of tenofovir-related effects is paramount as prolonged exposure may lead to persistent renal tubular damage and osteomalacia.<\/jats:p>","DOI":"10.1136\/bcr-2013-008674","type":"journal-article","created":{"date-parts":[[2013,7,10]],"date-time":"2013-07-10T03:04:30Z","timestamp":1373425470000},"page":"bcr2013008674","source":"Crossref","is-referenced-by-count":20,"title":["Tenofovir-related Fanconi\u2019s syndrome and osteomalacia in a teenager with HIV"],"prefix":"10.1136","volume":"2013","author":[{"given":"Julie M","family":"Lucey","sequence":"first","affiliation":[{"name":"Department of Immunology & Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Immunology & Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John B","family":"Ziegler","sequence":"additional","affiliation":[{"name":"Department of Immunology & Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,7,9]]},"reference":[{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.1","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1053\/ajkd.2002.36924","article-title":"Fanconi syndrome and renal failure induced by tenofovir: a first case report","volume":"2013","author":"Verhelst","year":"2002","journal-title":"Am J Kidney Dis"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.2","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1007\/s00467-006-0109-3","article-title":"Nephrotoxicity in a child with perinatal HIV on tenofovir, didanosine and lopinavir\/ritonavir","volume":"2013","author":"Hussain","year":"2006","journal-title":"Pediatr Nephrol"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.3","doi-asserted-by":"crossref","first-page":"e711","DOI":"10.1542\/peds.2005-2525","article-title":"Tenofovir disoproxil fumarate and an optimized background regimen of antiretroviral agents as salvage therapy: impact on bone mineral density in HIV-infected children","volume":"2013","author":"Gafni","year":"2006","journal-title":"Pediatrics"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.4","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1093\/cid\/cis937","article-title":"Association between tenofovir exposure and reduced kidney function in a cohort of HIV-positive patients: results from 10 Years of follow-up","volume":"2013","author":"Laprise","year":"2013","journal-title":"Clin Infect Dis"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.5","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1542\/peds.104.6.1394","article-title":"Resolution of HIV-associated nephrotic syndrome with highly active antiretroviral therapy delivered by gastrostomy tube","volume":"2013","author":"Viani","year":"1999","journal-title":"Pediatrics"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.6","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1086\/499048","article-title":"Tenofovir-associated acute and chronic kidney disease: a case of multiple drug interactions","volume":"2013","author":"Zimmermann","year":"2006","journal-title":"Clin Infect Dis"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.7","unstructured":"International Society for Clinical Densitometry Official Positions. http:\/\/www.iscd.org. Updated 2007. (accessed Jul 2012)."},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.8","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Clinical practice guideline: evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline","volume":"2013","author":"Holick","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.9","unstructured":"http:www.aidsinfo.nih.gov\/ContentFiles\/AdultandAdolescentGL.pdf (accessed on 14 Feb 2013, p. 41)."},{"issue":"Suppl 1","key":"2025082702563882000_2013.jul08_2.bcr2013008674.10","first-page":"26","article-title":"Renal tubular dysfunction associated with tenofovir based HAART in perinatally acquired HIV: the need for paediatric formulations and pharmacokinetic studies (Abstracts of the 14th Annual Conference of the British HIV Association)","volume":"2013","author":"Onyeador","year":"2008","journal-title":"HIV Med"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.11","first-page":"78","article-title":"Incomplete reversibility of tenofovir-related renal toxicity in HIV-infected men","volume":"2013","author":"Wever","year":"2010","journal-title":"J AIDS"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.12","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jinf.2005.07.014","article-title":"Tenofovir-induced renal tubular dysfunction presenting with hypocalcaemia","volume":"2013","author":"Williams","year":"2006","journal-title":"J Infect"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.13","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/QAD.0b013e3283333680","article-title":"Effect of tenofovir disoproxil fumarate on risk of renal abnormality in HIV-1-infected children on antiretroviral therapy: a nested case-control study","volume":"2013","author":"Judd","year":"2010","journal-title":"AIDS"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.14","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.jpeds.2007.12.020","article-title":"Decreased bone mineral density with off-label use of Tenofovir in HIV-infected children and adolescents.","volume":"2013","author":"Purdy","year":"2008","journal-title":"J Paediatr"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.15","first-page":"1001","article-title":"Tenofovir-induced osteomalacia","volume":"2013","author":"Wanner","year":"2009","journal-title":"Clin Exp Rheumatol"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.16","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1089\/aid.2008.0183","article-title":"High frequency of vitamin D deficiency in ambulatory HIV positive patients","volume":"2013","author":"Rodriguez","year":"2009","journal-title":"Aids Res Hum Retro"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.17","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1038\/ki.2008.326","article-title":"Will there be an epidemic of HIV-related chronic kidney disease in sub-Saharan Africa? Too soon to tell","volume":"2013","author":"Wools-Kaloustian","year":"2008","journal-title":"Kidney Int"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.18","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1097\/QAD.0b013e328307a051","article-title":"Baseline renal insufficiency and risk of death among HIV-infected adults on antiretroviral therapy in Lusaka, Zambia","volume":"2013","author":"Mulenga","year":"2008","journal-title":"AIDS"},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.19","unstructured":"WHO. Antiretroviral therapy for HIV infection in adults and adolescents: recommedations for a public health approach. http:\/\/www.who.int\/hiv\/pub\/guidelines\/artadultguidelines.pdf (accessed 5 Apr 2013). 2010."},{"key":"2025082702563882000_2013.jul08_2.bcr2013008674.20","unstructured":"Department of Health and Human Services. Guidelines for the use of antiretroviral Agents in pediatric HIV infection. DHSS. 2012. http:\/\/aidsinfo.nih.gov\/guidelines\/html\/2\/pediatric-arv-guidelines\/0 (accessed 5 Feb 2013)."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2013-008674","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:57:06Z","timestamp":1756288626000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2013-008674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,7,9]]},"references-count":20,"alternative-id":["10.1136\/bcr-2013-008674"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2013-008674","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.725999982.793512227","asserted-by":"object"}]},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,7,9]]}}}