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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