{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:27:51Z","timestamp":1786739271631,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:p>Hypophosphatemic osteomalacia in an adult often gives clinical diagnostic challenges. Usually, they are caused by either tumor-induced osteomalacia or due to genetically mediated hypophosphatemia, particularly X-linked hypophosphatemia. However, heavy metal toxicity, leading to global proximal renal tubular dysfunction, is a rare cause, and in particular, cadmium toxicity is rarely encountered in clinical practice. The presence of bony pain and neurological deficit, along with a classical exposure history, provides the diagnostic clue. In this background, here we present a middle-aged man who had severe bony pains all over his body and lower back stiffness for five years. He underwent an initial workup as a suspected spondyloarthropathy but was later on, found to have hypophosphatemic osteomalacia and severe proximal renal tubular dysfunction. Further, the workup revealed elevated FGF-23. His occupational history revealed prolonged exposure to cadmium fumes in the silverware industry. He improved moderately with treatment; however, significant renal damage is still present. This case highlights the importance of considering cadmium toxicity in proper clinical and occupational contexts in the evaluation of hypophosphatemic osteomalacia in an adult.<\/jats:p>","DOI":"10.4103\/jfmpc.jfmpc_1836_23","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T06:19:51Z","timestamp":1718345991000},"page":"2516-2519","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Hypophosphatemic osteomalacia due to cadmium toxicity in silverware industry: A curious case of aches and pains"],"prefix":"10.4103","volume":"13","author":[{"given":"Ayan","family":"Roy","sequence":"first","affiliation":[{"name":"Endocrinology and Metabolism, AIIMS, Kalyani, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taurja","family":"Saha","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism, AIIMS, Kalyani, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayaprakash","family":"Sahoo","sequence":"additional","affiliation":[{"name":"Endocrinology, JIPMER, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abanti","family":"Das","sequence":"additional","affiliation":[{"name":"Radiodiagnosis, AIIMS, Kalyani, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,6,14]]},"reference":[{"key":"R1-20260204","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/jbmr.4486","article-title":"An expert perspective on phosphate dysregulation with a focus on chronic hypophosphatemia","volume":"37","author":"Aljuraibah","year":"2022","journal-title":"J Bone Miner Res"},{"key":"R2-20260204","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1265\/jjh.67.455","article-title":"[Itai-itai disease: Cadmium-induced renal tubular 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study","volume":"31","author":"Wallin","year":"2016","journal-title":"J Bone Miner Res"},{"key":"R9-20260204","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1002\/jbmr.224","article-title":"Long-term cadmium exposure and the association with bone mineral density and fractures in a population-based study among women","volume":"26","author":"Engstr\u00f6m","year":"2011","journal-title":"J Bone Miner Res"},{"key":"R10-20260204","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1289\/ehp.11167","article-title":"Bone resorption and environmental exposure to cadmium in women: A population study","volume":"116","author":"Schutte","year":"2008","journal-title":"Environ Health Perspect"},{"key":"R11-20260204","doi-asserted-by":"crossref","first-page":"95","DOI":"10.2152\/jmi.57.95","article-title":"Fibroblast growth factor 23 mediates the phosphaturic actions of cadmium","volume":"57","author":"Aranami","year":"2010","journal-title":"J Med 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A study of 11 autopsies","volume":"196","author":"Takebayashi","year":"2000","journal-title":"Pathol Res Pract"},{"key":"R14-20260204","article-title":"Cadmium toxicity and treatment","author":"Bernhoft","year":"2013","journal-title":"ScientificWorldJournal 2013"},{"key":"R15-20260204","first-page":"135","article-title":"Cadmium toxicity and treatment: An update","volume":"8","author":"Rafati Rahimzadeh","year":"2017","journal-title":"Caspian J Intern Med"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1836_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:27:26Z","timestamp":1786735646000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1836_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6]]},"references-count":15,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_1836_23","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6]]},"assertion":[{"value":"2023-11-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-17","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}