Table 3 Current clinical treatment options for tumor-induced osteomalacia (TIO)
From: A rare cause of atraumatic fractures: case series of four patients with tumor-induced osteomalacia
Treatment option | When it is appropriate | Recommended Monitoring |
|---|---|---|
Tumor resection with wide surgical margins | In cases of an identifiable lesion on localization studies in patients who are surgical candidates | • Post-operatively, the serum phosphorus is expected to normalize after discontinuation of phosphorus and calcitriol supplementation. • If there is suboptimal tumor resection, monitor for persistent or recurrent TIO |
Phosphorus (15–60 mg/kg per day divided into 4–6 doses) and calcitriol supplementation (15–60 ng/kg per day divided into 2–3 doses) | In cases where no lesion is identified on localization studies, complete resection of the tumor is not possible, or the patient is not a surgical candidate | • Monitor serum phosphorus, calcium, intact parathyroid hormone, alkaline phosphatase, and urinary calcium to urinary creatinine ratio • Goal is to maintain serum phosphorus in the lower end of the age-appropriate normal range; serum calcium, parathyroid hormone, and alkaline phosphatase within the normal range; and the spot urine calcium to urine creatinine ratio < 0.2. |
Cinacalcet | As adjuvant therapy to phosphorus and calcitriol supplementation | • Monitor urinary calcium for development of hypercalciuria |
Burosumab (human monoclonal antibody against FGF23) | This new drug shows promise in treating patients with TIO in whom the lesion cannot be identified or in whom surgical resection is not possible | • In clinical trials, monitoring of serum phosphorus, TmP/GFR, 1,25-dihydroxyvitamin D, and bone turnover markers (procollagen type 1 N-terminal propeptide and collagen type 1 C-telopeptide) is performed |