{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T03:23:11Z","timestamp":1774063391319,"version":"3.50.1"},"reference-count":14,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,9,14]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>A 76-year-old woman was treated with oral bisphosphonate, alendronate, for osteoporosis in an outpatient clinic. Routine blood tests 4 months after alendronate prescription surprisingly revealed severe hypophosphataemia. The patient was hospitalised and treated with intravenous and oral phosphate supplements. Alendronate was later reintroduced as treatment for osteoporosis and the patient once again presented with severe hypophosphataemia in subsequent routine blood tests. The patient had only presented with lower extremity pain, muscle weakness and difficulty walking. Blood tests in the emergency department both times reconfirmed severe hypophosphataemia. Plasma (p-)ionised calcium levels were normal or slightly elevated and p-parathyroid hormone levels were normal or slightly suppressed. The p-25-hydroxyvitamin-D and p-creatine were in the normal range. Critical illness, malabsorption, nutritional issues and genetics were reviewed as potential causes but considered unlikely. Phosphate levels were quickly restored each time on replacement therapy and the case was interpreted as bisphosphonate-induced severe hypophosphataemia.<\/jats:p>","DOI":"10.1136\/bcr-2020-235083","type":"journal-article","created":{"date-parts":[[2020,10,8]],"date-time":"2020-10-08T17:15:20Z","timestamp":1602177320000},"page":"e235083","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Severe hypophosphataemia following oral bisphosphonate treatment in a patient with osteoporosis"],"prefix":"10.1136","volume":"13","author":[{"given":"Louise Wulff","family":"Bagger","sequence":"first","affiliation":[{"name":"Department of Internal Medicine M, Geriatric Section, Amager Hvidovre Hospital, Glostrup, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Per Kim Dyhr","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine M, Geriatric Section, Amager Hvidovre Hospital, Glostrup, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark"},{"name":"Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara Rubek","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine M, Geriatric Section, Amager Hvidovre Hospital, Glostrup, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,10,8]]},"reference":[{"key":"2025082707223967000_13.10.e235083.1","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1080\/10790268.2006.11753890","article-title":"Effect of a convenient single 90-mg pamidronate dose on biochemical markers of bone metabolism in patients with acute spinal cord injury","volume":"29","author":"Mechanick","year":"2006","journal-title":"J Spinal Cord Med"},{"key":"2025082707223967000_13.10.e235083.2","doi-asserted-by":"publisher","DOI":"10.1177\/0897190015624050"},{"key":"2025082707223967000_13.10.e235083.3","doi-asserted-by":"crossref","first-page":"267","DOI":"10.2174\/1574886311666160426141647","article-title":"Zoledronate induced hypocalcemia and hypophosphatemia in osteoporosis: a cause of concern","volume":"11","author":"Kaur","year":"2016","journal-title":"Curr Drug Saf"},{"key":"2025082707223967000_13.10.e235083.4","first-page":"24","article-title":"Profound and protracted hypophosphatemia after a single dose of zoledronic acid Infudion for osteoporosis associated with Normocalcemic primary hyperparathyroidism","volume":"3","author":"Chiam","year":"2017","journal-title":"iMedPub Journals"},{"key":"2025082707223967000_13.10.e235083.5","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/S2213-8587(19)30426-7","article-title":"Approach to patients with hypophosphataemia","volume":"8","author":"Florenzano","year":"2020","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2025082707223967000_13.10.e235083.6","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcq039"},{"key":"2025082707223967000_13.10.e235083.7","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200161060-00010"},{"key":"2025082707223967000_13.10.e235083.8","unstructured":"Food and Drug Administration . 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