Korean J Gastroenterol.  2010 Aug;56(2):117-120. 10.4166/kjg.2010.56.2.117.

A Case of Osteomalacia Related to Adefovir in a Patient with Chronic Hepatitis B

• Ahn SY
• Ko SY
• Jang YM
• Choi YH
• Kim BK
• Choe WH
• Lee CH
• Kwon SY

• KMID: 1775868
• DOI: http://doi.org/10.4166/kjg.2010.56.2.117

Abstract

Adefovir dipivoxil, an acyclic nucleoside analogue, has been approved for the treatment of patients with chronic hepatitis B. This agent is efficacious particularly in those who have developed lamivudine resistance. The report according to hypophosphatemia induced by low dose adefovir therapy is very rare. We report one case in which osteomalacia with hypophosphatemia developed in a patient with chronic hepatitis B on adefovir dipivoxil at a low dose, 10 mg daily. A 66-year-old man, who had been taking adefovir for more than 4 years due to lamivudine resistance, presented with muscle weakness and bone pain in both thighs. After 3 years of adefovir therapy, hypophosphatemia and elevated serum alkaline phosphatase levels had been noted. A bone scan showed multiple hot uptakes. All the image findings and clinical symptoms, such as bone pain and muscle weakness were improved after correcting the hypophosphatemia with oral phosphorous supplementation.

Keyword

Hypophosphatemia; Osteomalacia; Adefovir

MeSH Terms

Adenine/adverse effects/*analogs & derivatives/therapeutic use
Aged
Alkaline Phosphatase/blood
Antiviral Agents/*adverse effects/therapeutic use
DNA, Viral/blood
Dietary Supplements
Hepatitis B, Chronic/*drug therapy
Humans
Hypophosphatemia/*chemically induced/complications
Liver Cirrhosis/diagnosis
Male
Osteomalacia/*diagnosis/etiology
Phosphates/blood
Phosphonic Acids/*adverse effects/therapeutic use
Whole Body Imaging

Figure

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  Fig. 1. Whole body bone scan findings. (A) On the initial bone scan, increased hot uptakes were noted on the ribs, both femurs and left proximal tibia. (B) Hot uptakes of multifocal bony lesions decreased 7 months after oral phosphorous supplementation.

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  Fig. 2. Changes of serum level of inorganic phosphate (IP) and alkaline phosphatase (ALP) had a correlation with oral phosphorous supplementation. Solid square and circle demonstrated the level of IP and ALP at the 57-month follow-up. ADV, adefovir dipivoxil; LMV, lamivudine.

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