J Korean Fract Soc.  2017 Jul;30(3):146-150. 10.12671/jkfs.2017.30.3.146.

Oncogenic Osteomalacia with Multiple Insufficiency Fractures: A Case Report

• Park YC
• Seo JO
• Yang KH

• KMID: 2424124
• DOI: http://doi.org/10.12671/jkfs.2017.30.3.146

Abstract

Oncogenic osteomalacia is a rare paraneoplastic syndrome, characterized by hypophosphatemia, renal phosphate wasting, osteomalacia, and multiple insufficiency fractures, as a result of the tumor. A wide excision of the causative tumor is considered as the treatment of choice, following which, a dramatic recovery is expected. Authors report a case in which the symptoms and bone mineral density were dramatically recovered after an excision of the causative tumor around the tibialis posterior muscle in oncogenic osteomalacia.

Keyword

Oncogenic osteomalacia; Insufficiency fractures; Hypophosphatemia

MeSH Terms

Bone Density
Fractures, Stress*
Hypophosphatemia
Osteomalacia*
Paraneoplastic Syndromes

Figure

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  Fig. 1 Spine simple x-ray lateral view shows that vertebral height of T10, 11, 12, L1, and 2 decreased slightly (A) and magnetic resonance imaging T1-weighted enhanced image shows multiple compression fracture (B).

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  Fig. 2 Whole body bone scan shows multifocal bony uptakes in the bilateral ribs, pelvis, femoral neck, knee, and ankle. RT: right, LT: left.

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  Fig. 3 Insufficiency fracture of the femoral neck. A lucent line (arrow) is called a Looser's zone or pseudofracture.

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  Fig. 4 (A, B) Tumor localization. Causative tumor (arrows) was found on the left lower leg by Octreoscan. (C) Magnetic resonance imaging T2-weighted image shows 4.5×2.0×2.0-cm-sized soft tissue tumor located at the tibialis posterior muscle belly. Tumor had a round, well-defined margin with heterogeneous signal intensity. RT: right.

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  Fig. 5 Intraoperative image. Tumor was excised completely.

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  Fig. 6 Bone mineral density (BMD) change. Compared to the preoperative status, BMD and Z-score at 1 year and six months follow-up after surgery showed good recovery. BMC: bone mineral content.

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