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J Bone Miner Res. 2018 Mar;33(3):534-539. doi: 10.1002/jbmr.3319. Epub 2017 Nov 21.

Hypophosphatemia, Severe Bone Pain, Gait Disturbance, and Fatigue Fractures After Iron Substitution in Inflammatory Bowel Disease: A Case Report.

Author information

1
Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept., Hanusch Hospital, Vienna, Austria.
2
Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Vienna, Austria.

Abstract

Intravenous infusions of different iron formulations are recognized as a cause of hypophosphatemia. Chronic hypophosphatemia can alter bone metabolism and bone material structure. As a consequence, osteomalacia may develop and lead to bone fragility. Herein, we report a patient with Crohn's disease presenting with persistent hypophosphatemia and insufficiency fractures while receiving regular iron infusions due to chronic gastrointestinal bleeding. Previously, the patient regularly received vitamin D and also zoledronic acid. The patient underwent bone biopsy of the iliac crest that showed typical signs of osteomalacia with dramatically increased osteoid volume and decreased bone formation. Analysis of the bone mineralization density distribution (BMDD) revealed a more complex picture: On the one hand, there was a shift to higher matrix mineralization, presumably owing to low bone turnover; on the other hand, a broadening of the BMDD indicating more heterogeneous mineralization due to osteomalacia was also evident. This is the first report on changes of bone histomorphometry and bone matrix mineralization in iron-induced osteomalacia.

KEYWORDS:

CROHN'S DISEASE; FGF23; FRACTURE; HYPOPHOSPHATEMIA; INFLAMMATORY BOWEL DISEASE; IRON INFUSION; OSTEOMALACIA

PMID:
29068481
DOI:
10.1002/jbmr.3319

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