title: Severe hypophosphatemic osteomalacia secondary to fanconi syndrome due to adefovir: a case report.
abstract: OBJECTIVE
  Generalized proximal, type 2, renal tubular acidosis, also known as Fanconi syndrome, is a generalized dysfunction of the proximal renal tubule characterized by impaired reabsorption and increased urinary loss of phosphate and other solutes, such as uric acid, glucose, amino acids, and bicarbonate. Chronic hypophosphatemia is the second most common cause of osteomalacia after vitamin D deficiency in adult patients and can have a heterogeneous presentation, ranging from mild symptoms such as muscle weakness and skeletal pain to more severe presentation, such as disabling myopathy, severe bone and joint pain, difficulty walking, and even bone fractures.
  
  
  METHODS
  This report describes a case of severe hypophosphatemic osteomalacia with multiple fragility fractures induced by adefovir, which was worsened and confounded by a previous treatment with zoledronic acid and required prolonged intravenous potassium phosphate administration.
  
  
  RESULTS
  We highlight the limited diagnostic value of dual X-ray absorptiometry and bone scintigraphy in this challenging diagnosis. Bone metabolism should always be assessed in patients treated with adefovir for early detection of osteomalacia due to Fanconi syndrome.
  
  
  CONCLUSIONS
  Although rare, this condition may be life-threatening and mimic other bone metabolic disorders that are treated with drugs that may further impair phosphate balance.
authors.affiliation: Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Palermo
authors.affiliation: Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Italy.
authors.forename: Rocky
authors.initials: R
authors.lastname: Strollo
authors.affiliation: Department of Orthopedics, University Campus Bio-Medico of Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
authors.affiliation: Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: D'Onofrio
authors.affiliation: Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Maddaloni
authors.affiliation: Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Italy.
authors.forename: Silvia Irina
authors.initials: SI
authors.lastname: Briganti
authors.affiliation: Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Napoli
authors.affiliation: Department of Hepatology, University Campus Bio-Medico of Rome, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Vespasiani
authors.affiliation: Department of Internal Medicine, University Campus Bio-Medico of Rome, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Costantino
authors.affiliation: Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Italy Centre for Diabetes, The Blizard Building, Barts and The London School of Medicine, Queen Mary, University of London, London, United Kingdom.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pozzilli
authors.affiliation: Department of Orthopedics, University Campus Bio-Medico of Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
authors.affiliation: Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Manfrini