ReviewTherapeutic advances in endocrinology and metabolism2017
Long-term iron polymaltose infusions associated with hypophosphataemic osteomalacia: a report of two cases and review of the literature.
Review in Therapeutic advances in endocrinology and metabolism, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Osteomalacia as a Complication of Intravenous Iron Infusion: A Systematic Review of Case Reports.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Pooled it
- Randomized trial of intravenous iron-induced hypophosphatemia.JCI insight · 2018Trial
- Hypophosphataemia following iron infusion: a narrative review of an increasingly recognised complication.Internal medicine journal · 2026Review
- A retrospective analysis of the prevalence of hypophosphatemia and hypocalcemia after intravenous iron polymaltose in the inpatient setting.JBMR plus · 2025Article
- Understanding and Managing Infusion Reactions and Hypophosphataemia With Intravenous Iron-A Nurses' Consensus Paper.Nursing open · 2025Article
- iFGF23 Plasma Levels in Transfusion-Dependent β-Thalassemia: Insights into Bone and Iron Metabolism.Journal of clinical medicine · 2025Article
- Intravenous Iron (III) Hydroxide Polymaltose Complex Infusion Related Severe Prolonged Hypophosphatemia.Cureus · 2025Article
- Treatment Advances in Tumor-Induced Osteomalacia.Calcified tissue international · 2025Review
- Global guidance for the recognition, diagnosis, and management of tumor-induced osteomalacia.Journal of internal medicine · 2023Review
- High-Dose Intravenous Iron with Either Ferric Carboxymaltose or Ferric Derisomaltose: A Benefit-Risk Assessment.Drug safety · 2022Article
- Severe hypocalcaemia following denosumab and iron infusion.Nephrology (Carlton, Vic.) · 2022Article
- Severe Hypophosphatemia Occurring After Repeated Exposure to a Parenteral Iron Formulation.Case reports in endocrinology · 2022Article
- Intravenous Iron-Induced Hypophosphatemia: An Emerging Syndrome.Advances in therapy · 2021Review
- The Causes of Hypo- and Hyperphosphatemia in Humans.Calcified tissue international · 2021Review
- Congenital Conditions of Hypophosphatemia in Children.Calcified tissue international · 2021Review
- A Pooled Analysis of Serum Phosphate Measurements and Potential Hypophosphataemia Events in 45 Interventional Trials with Ferric Carboxymaltose.Journal of clinical medicine · 2020Article
- High Risk of Hypophosphatemia in Patients with Previous Bariatric Surgery Receiving Ferric Carboxymaltose: A Prospective Cohort Study.Obesity surgery · 2020Article
- FGF23 at the crossroads of phosphate, iron economy and erythropoiesis.Nature reviews. Nephrology · 2020Review
- Regulation of Fibroblast Growth Factor 23 by Iron, EPO, and HIF.Current molecular biology reports · 2019Article
- Management of anemia in inflammatory bowel disease: a challenge in everyday clinical practice.Przeglad gastroenterologiczny · 2017Review
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Iron-induced hypophosphataemic osteomalacia remains under-recognized as a potential complication of parenteral iron therapy. We here report two cases of symptomatic hypophosphataemic osteomalacia with multiple insufficiency fractures in the context of chronic gastrointestinal blood loss, necessitating monthly iron polymaltose infusions over prolonged periods of time. Respective blood tests revealed severe hypophosphataemia [0.29 and 0.43; normal range (NR) 0.8-1.5 mmol/l] in the presence of normal serum calcium and 25-hydroxy vitamin D levels. Urinary fractional phosphate excretion was elevated (16% and 24%; NR < 5%) and the tubular maximum phosphate reabsorption was reduced, consistent with renal phosphate wasting. Serum fibroblast growth factor 23 (FGF23) obtained in one patient was significantly elevated at 285 pg/ml (NR < 54 pg/ml). Bone mineral density was significantly reduced and whole-body bone scans revealed metabolic bone disease and multiple insufficiency fractures consistent with osteomalacia. Cessation of iron infusions resulted in clinical and biochemical improvement within 2 months in one patient whereas the second patient required phosphate and calcitriol supplementation to improve symptomatically. Iron-induced hypophosphataemic osteomalacia is thought to be due to reduced degradation of FGF23, resulting in phosphaturia and reduced synthesis of 1,25-dihydroxy vitamin D. Monitoring of patients on long-term parenteral iron is recommended to avoid clinically serious adverse effects.
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