Artralgias y fracturas en un varón adulto: más allá de la hipovitaminosis D

Osteomalacia as a Complication of Intravenous Iron Infusion: A Systematic Review of Case Reports

“…Gastrointestinal diseases were by far the most common cause of iron deficiency (23 cases); 9 patients had inflammatory bowel disease (IBD), ( 11‐13,19,22,24,28,29,34 ) 5 had intestinal vascular ectasia, ( 14,15,20,23 ) 4 had short bowel (including one Roux‐en‐Y gastric bypass [RYGB]), ( 22,25,32,37 ) 3 patients had bleeding associated with cirrhosis, ( 16,27,33 ) 1 had gastritis, ( 30 ) 1 had a duodenal ulcer, ( 18 ) and 1 patient had celiac disease. ( 17 ) Five patients received intravenous iron for gynecological bleeding ( 26,31,35,36 ) and 2 for unknown reasons.…”

“…In 10 patients, no previous identifiable condition harmful to the skeleton was reported, ( 14,18,20,21,26,31,33,35,38 ) whereas 9 patients had IBD, ( 11‐13,19,22,24,28,29,34 ) associated with malabsorption and/or glucocorticoid use, 4 patients had short bowel, ( 22,25,32,37 ) 3 had diabetes, ( 14,15,30 ) and 1 had malabsorption associated with celiac disease. ( 17 ) In 10 patients, vitamin D was reported to be low.…”

“…( 17 ) In 10 patients, vitamin D was reported to be low. ( 12,15,16,19,22,23,27,30,34,36 ) In these, 6 also had high parathyroid hormone (PTH), ( 15,16,19,27,30,36 ) 4 also had low calcium levels, (16,22,27,34 ) and 6 also had high ALP, ( 15,16,19,22,27,30 ) suggesting vitamin D deficiency in 8 of them. In the remaining 2 patients, low vitamin D was associated with normal calcium.…”

“…Bone mineral density was reported in 16 patients; in 5 it was normal, ( 18,20,30,36,37 ) 3 had osteopenia, (14,23,24 ) and 8 had osteoporosis. ( 13‐16,19,32‐34 ) In 2 cases, bone mineral density (BMD) was also available after hypophosphatemia recovery and both showed increases; an 8% increase in femoral neck BMD and 19% increase in lumbar spine (LS) after 12 months was reported by Tournis ( 32 ) and a substantial 63% increase in femoral neck (FN) BMD after 30 months was reported by Nomoto.…”

“…The most common areas affected were the ribs (in 12 patients), ( 12,14,15,19,21,22,24,29,30,36,37 ) the pelvis (in 8 patients), ( 15,21‐24,26,29,39 ) and the femur ( 11,15,24,26,28 ) and the feet (in 5 patients each). ( 15,24,26,29,30 ) Bone biopsy was performed in 4 cases ( 13,20,24,28 ) and showed osteomalacia in 3. ( 13,24,28 ) Six patients underwent PET‐FDG ( 15,19,20,23,24,34 ) and 2 octreotide ( 28,34 ) scans looking for tumors as a source of FGF23 but all were negative.…”