{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:14:06Z","timestamp":1782602046217,"version":"3.54.5"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>Osteomalacia is a relatively common condition, which is frequently underdiagnosed due to lack of clinical suspicion and non-specific symptoms. Osteomalacia can complicate tubulo-interstital nephritis. However, it occurs exceptionally as the first manifestation of Sj\u00f6gren syndrome with renal involvement. It is a consequence of chronic metabolic acidosis and is associated with distal renal tubular acidosis. We report a 31-year-old woman hospitalised for a 1\u2005year history of muscle weakness and joint and chest wall pains. Skeletal imagery showed Looser\u2019s zones in the left femoral neck. Investigations concluded to the diagnosis of primary Sjogren's syndrome.<\/jats:p>","DOI":"10.1136\/bcr-2013-201052","type":"journal-article","created":{"date-parts":[[2013,10,9]],"date-time":"2013-10-09T15:40:31Z","timestamp":1381333231000},"page":"bcr2013201052","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Osteomalacia as inaugural manifestation of Sj\u00f6gren syndrome"],"prefix":"10.1136","volume":"2013","author":[{"given":"Eya","family":"Cherif","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lamia","family":"Ben Hassine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zouleikha","family":"Kaoueche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narjess","family":"Khalfallah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2013,10,9]]},"reference":[{"key":"2025042709265274000_2013.oct09_1.bcr2013201052.1","first-page":"17","article-title":"Osteomalacia: what the rheumatologist needs to know","volume":"2013","author":"Arya","year":"2007","journal-title":"Indian J Rheumatol"},{"key":"2025042709265274000_2013.oct09_1.bcr2013201052.2","first-page":"313","article-title":"Sj\u00f6gren's syndrome","volume":"2013","author":"Venables","year":"2004","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2025042709265274000_2013.oct09_1.bcr2013201052.3","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/j.1742-1241.1998.tb08898.x","article-title":"Primary Sj\u00f6gren's syndrome presenting as osteomalacia secondary to renal tubular acidosis","volume":"2013","author":"Pal","year":"1998","journal-title":"Br J Clin Pract"},{"key":"2025042709265274000_2013.oct09_1.bcr2013201052.4","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3109\/00365599509180018","article-title":"Biochemical markers of renal disease in primary Sj\u00f6gren's syndrome","volume":"2013","author":"Eriksson","year":"1995","journal-title":"Scand J Urol Nephrol"},{"key":"2025042709265274000_2013.oct09_1.bcr2013201052.5","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/00005792-200007000-00005","article-title":"Clinically significant and biopsy-documented renal involvement in primary Sj\u00f6gren syndrome","volume":"2013","author":"Goules","year":"2000","journal-title":"Medicine (Baltimore)"},{"key":"2025042709265274000_2013.oct09_1.bcr2013201052.6","doi-asserted-by":"crossref","first-page":"271","DOI":"10.5001\/omj.2011.66","article-title":"Distal renal tubular acidosis, hypokalemic paralysis, nephrocalcinosis. 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