{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:25Z","timestamp":1784557045410,"version":"3.55.0"},"reference-count":11,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Tenofovir-induced osteomalacia secondary to proximal renal tubular dysfunction is not an uncommon complication known to occur. A 46-year-old woman was referred for the evaluation of osteoporosis which was diagnosed elsewhere. She had polyarthralgia, bony pains and proximal muscle weakness of 1 year duration. She was diagnosed to have HIV infection and was on antiretroviral therapy that consisted of tenofovir, lamivudine and efavirenz for the past 12 years. She had attained menopause 5 years back. On examination, she had bone tenderness, proximal myopathy and painful restriction of movement of her lower limbs. Investigations showed features of renal tubular acidosis, hypophosphatemia and raised alkaline phosphatase that were suggestive of osteomalacia. X-ray of the pelvis showed diffuse osteopenia and an MRI of the pelvis done showed multiple insufficiency fractures involving the head of femur on both sides. Following this, her tenofovir-based regimen was changed to abacavir, efavirenz and lamivudine with addition of neutral phosphate supplements and calcitriol. On follow-up after 6 months, she had significant improvement in her symptoms as well as in the bone mineral density at the lumbar spine (33.2%), femoral neck (27.6%), trabecular bone score (13.2%) and reduction in the buckling ratio at the narrow neck (6.3%), inter-trochanteric region (34%) and femoral shaft (28.8%). Tenofovir-induced osteomalacia is encountered in individuals on prolonged treatment with tenofovir. Treatment consists of changing to a non-tenofovir-based regimen, as well as supplementation of phosphate and calcitriol. Treatment results in remarkable improvement in symptoms and most densitometric indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Tenofovir is a nucleotide reverse transcriptase inhibitor (NRTI) and is a major drug in the treatment of retroviral and hepatitis B infections.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Tenofovir-related hypophosphatemic osteomalacia is related to proximal tubulopathy and is not an uncommon occurrence.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Treatment mandates changing to a non-tenofovir-based regimen with supplementation of neutral phosphate and calcitriol.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Treatment results in a significant improvement in bone mineral density, trabecular bone score and hip geometric parameters.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-22-0259","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T08:40:59Z","timestamp":1677660059000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":5,"title":["Tenofovir-induced hypophosphatemic osteomalacia: how do bone mineral density, trabecular bone score and proximal hip geometry change with treatment?"],"prefix":"10.1530","volume":"2023","author":[{"given":"Aneez","family":"Joseph","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9249-3719","authenticated-orcid":true,"given":"Kripa Elizabeth","family":"Cherian","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Kapoor","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3315-341X","authenticated-orcid":true,"given":"Thomas V","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Journal of the International Association of Providers of AIDS Care","first-page":"2325958220919231","article-title":"A review and clinical understanding of tenofovir: tenofovir disoproxil fumarate versus tenofovir Alafenamide","volume":"19","author":"Wassner","year":"2020","unstructured":"Wassner CBradley NLee Y. 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(https:\/\/doi.org\/10.1089\/apc.2007.0052)"},{"key":"bib8","series-title":"Antimicrobial Agents and Chemotherapy","first-page":"1840","article-title":"Tenofovir plasma concentrations according to companion drugs: a cross-sectional study of HIV-positive patients with normal renal function","volume":"57","author":"Calcagno","year":"2013","unstructured":"Calcagno AGonzalez de Requena DSimiele MD\u2019Avolio ATettoni MCSalassa BOrofino GBramato CLibanore VMotta ITenofovir plasma concentrations according to companion drugs: a cross-sectional study of HIV-positive patients with normal renal function. Antimicrobial Agents and Chemotherapy2013571840\u20131843. (https:\/\/doi.org\/10.1128\/AAC.02434-12)"},{"key":"bib9","series-title":"Clinical Rheumatology","first-page":"1271","article-title":"Hypophosphatemic osteomalacia induced by tenofovir in HIV-infected patients","volume":"35","author":"Mateo","year":"2016","unstructured":"Mateo LHolgado SMari\u00f1oso MLP\u00e9rez-Andr\u00e9s RBonjoch ARomeu JOlive A. Hypophosphatemic osteomalacia induced by tenofovir in HIV-infected patients. Clinical Rheumatology2016351271\u20131279. (https:\/\/doi.org\/10.1007\/s10067-014-2627-x)"},{"key":"bib10","series-title":"Journal of Viral Hepatitis","first-page":"561","article-title":"Improvement of bone mineral density and markers of proximal renal tubular function in chronic hepatitis B patients switched from tenofovir disoproxil fumarate to tenofovir alafenamide","volume":"26","author":"Fong","year":"2019","unstructured":"Fong TLLee BTTien AChang MLim CAhn ABae HS. 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