{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T19:01:48Z","timestamp":1790276508979,"version":"4.1.0"},"reference-count":32,"publisher":"The Endocrine Society","issue":"2","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Tumor-induced osteomalacia (TIO) is a rare condition with evidence mostly derived from case reports and case series.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We aimed to describe the clinical characteristics of a large cohort of patients diagnosed with TIO, with a focus on patients with nonlocalizing and malignant TIO.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This is a retrospective cohort of patients with TIO in an academic medical center, diagnosed between January 1998 and May 2023. We describe their demographics, biochemistries, tumor features, localization, treatment, and complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 68 patients diagnosed with TIO, 49 (72%) were localizing and 5 (7.4%) were malignant. Of 50 patients who attempted localizing procedures, 29 (58%) achieved cure. Twenty (40%) had persistent disease due to the wrong tumor targeted, or refractory or recurrent tumors, despite up to 6 procedural attempts. There was no difference in demographics, phosphorus, or baseline fibroblast growth factor-23 (FGF23) levels between localizing vs nonlocalizing groups, and malignant vs nonmalignant groups. The lower extremity was the commonest site of localization (37%), with 47% in bone and 53% in soft tissue. Sixty percent of malignant cases were located in the trunk. Tumor size correlated with peak FGF23 (R = 0.566, P &amp;lt; .001) but was not associated with malignancy risk (P = .479). A cut-off FGF23 of &amp;gt;20 times upper limit of normal in the presence of normal renal function (P = .025) and recurrence after initial cure (P = .013) were factors significantly associated with malignancy. The nonlocalizing group had lower survival than the localizing group (P = .0097).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>TIO is a condition with significant morbidity. Very high FGF23 levels and disease recurrence are associated with malignant disease. Reasons behind the observation of higher mortality in nonlocalizing TIO should be further explored.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgae183","type":"journal-article","created":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T11:29:08Z","timestamp":1710847748000},"page":"e397-e411","source":"Crossref","is-referenced-by-count":16,"title":["A Retrospective Cohort of Tumor-Induced Osteomalacia and Case Series of Malignant Disease"],"prefix":"10.1210","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5206-5477","authenticated-orcid":false,"given":"Caroline Wei Shan","family":"Hoong","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Mayo Clinic Rochester , Rochester, MN 55905 ,","place":["USA"]},{"name":"Division of Endocrinology, Woodlands Health, National Healthcare Group ,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1576-1534","authenticated-orcid":false,"given":"Jad","family":"Sfeir","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Mayo Clinic Rochester , Rochester, MN 55905 ,","place":["USA"]},{"name":"Robert and Arlene Kogod Center on Aging, Mayo Clinic Rochester , Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4455-6217","authenticated-orcid":false,"given":"Alicia","family":"Algeciras-Schimnich","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester , Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3801-9546","authenticated-orcid":false,"given":"Bart Lyman","family":"Clarke","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Mayo Clinic Rochester , Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2024,3,20]]},"reference":[{"issue":"2","key":"2025012110280195800_dgae183-B1","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1210\/endrev\/bnac026","article-title":"Tumor-induced osteomalacia: a comprehensive review","volume":"44","author":"Minisola","year":"2023","journal-title":"Endocr Rev"},{"key":"2025012110280195800_dgae183-B2","doi-asserted-by":"crossref","first-page":"267","DOI":"10.3389\/fendo.2018.00267","article-title":"Physiological actions of fibroblast growth factor-23","volume":"9","author":"Erben","year":"2018","journal-title":"Front Endocrinol 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