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Tumour-Induced Osteomalacia: When Tumours Weaken Our Bones


Within the realm of medical mysteries, there are certain conditions that continue to baffle healthcare professionals. Tumour-induced osteomalacia (TIO) is one such rare and perplexing disorder. Despite its rarity, TIO has a significant impact on individuals, as it leads to weakened bones and a myriad of symptoms. In this blog, we will explore the fascinating world of tumour-induced osteomalacia, its causes, diagnostic challenges, and potential treatment options.

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Understanding Tumour-Induced Osteomalacia

Tumour-induced osteomalacia, also known as oncogenic osteomalacia, is an extremely rare paraneoplastic syndrome characterized by the development of bone softening and deformities. The condition is primarily caused by small benign tumors called phosphaturic mesenchymal tumours (PMTs) or, more specifically, by the excessive production of a hormone known as fibroblast growth factor 23 (FGF23). FGF23 is responsible for regulating phosphate and vitamin D levels in the body.

Causes and Pathophysiology

Tumour-induced osteomalacia occurs when these PMTs develop in bone or soft tissue, often in the extremities. These tumors produce and release excessive amounts of FGF23, which disrupts the normal balance of phosphate and vitamin D in the body. Consequently, there is an increased urinary excretion of phosphate and reduced absorption of dietary phosphate from the intestines, leading to hypophosphatemia (low levels of phosphate in the blood). This, in turn, impairs the mineralization of bones, resulting in osteomalacia.

Clinical Presentation and Diagnostic Challenges

The clinical presentation of tumour-induced osteomalacia is diverse and can often be misleading. Patients commonly experience bone pain, muscle weakness, fatigue, and an increased risk of fractures. These symptoms are often nonspecific and can be attributed to other conditions, making the diagnosis challenging.

Identifying the underlying PMT responsible for the condition is a key diagnostic challenge. These tumors are typically small, slow-growing, and difficult to detect using conventional imaging techniques. Localization studies, such as somatostatin receptor scintigraphy and positron emission tomography (PET), along with selective venous sampling for FGF23 levels, are often necessary to pinpoint the tumor’s location.

Treatment Options

The primary treatment for tumour-induced osteomalacia involves surgical removal of the underlying tumor responsible for the excessive FGF23 production. Once the tumor is successfully resected, phosphate and vitamin D levels gradually normalize, and the bone mineralization process improves. In some cases, if the tumor cannot be located or removed, medical management with phosphate and vitamin D supplements may be necessary to alleviate symptoms and prevent further bone deterioration.


Tumour-induced osteomalacia is a rare and complex disorder that can have a profound impact on an individual’s quality of life. The difficulty in diagnosing this condition and identifying the underlying tumor poses significant challenges for healthcare professionals. However, advancements in imaging techniques and diagnostic tools have improved the chances of successful localization and surgical intervention.

Awareness about tumour-induced osteomalacia is crucial, as early diagnosis and treatment can lead to a significant improvement in symptoms and prevent long-term complications. Further research is necessary to gain a deeper understanding of the underlying mechanisms of this condition and develop more effective treatment strategies.

By shedding light on this intriguing disorder, we can hope to encourage continued research and raise awareness among medical professionals, ultimately improving the lives of those affected by tumour-induced osteomalacia.

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