{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T02:22:06Z","timestamp":1772158926120,"version":"3.50.1"},"reference-count":18,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,4,22]]},"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>Tumour-induced osteomalacia is caused by tumorous production of fibroblast growth factor 23 (FGF23) leading to urinary phosphate wasting, hypophosphataemia and decreased vitamin D activation. The resulting osteomalacia presents with muscle weakness and bone pain but progresses to multiple pathological fractures. Patients often remain undiagnosed for years with severe physical, psychological and economic ramifications. A young woman presented with multiple spontaneous fractures including bilateral femoral fractures. Laboratory tests revealed severe hypophosphataemia, elevated bone turnover markers and low to normal calcium and 25-hydroxy-vitamin D levels. Treatment with phosphate, alfalcalcidol, calcium and magnesium was initiated. <jats:sup>68<\/jats:sup>Gallium-DOTATOC positron emission tomography imaging revealed a mass in the right foot and venous sampling of FGF23 from all extremities confirmed this tumour as the culprit. Biopsy and histology were consistent with a phosphaturic mesenchymal tumour, which was surgically resected. Phosphate levels quickly normalised postoperatively but a long convalescence with hungry bone syndrome, fracture healing and physical therapy followed.<\/jats:p>","DOI":"10.1136\/bcr-2023-258858","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T12:56:03Z","timestamp":1714654563000},"page":"e258858","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Tumour-induced osteomalacia: the long road to diagnosis and recovery"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7211-087X","authenticated-orcid":false,"given":"Shobitha","family":"Vollmer","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Skane University Hospital, Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Olsson","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Skane University Hospital, Lund, 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