Top

Published in:

01-12-2017 | Original Paper

Prevalence and clinical outcomes of hip fractures and subchondral insufficiency fractures of the femoral head in patients with tumour-induced osteomalacia

Authors: Hiroshi Kobayashi, Nobuaki Ito, Toru Akiyama, Tomotake Okuma, Yuka Kinoshita, Masachika Ikegami, Yusuke Shinoda, Seiji Fukumoto, Sakae Tanaka, Hirotaka Kawano

Published in: International Orthopaedics | Issue 12/2017

Abstract

Purpose

Tumour-induced osteomalacia (TIO) is a rare paraneoplastic syndrome usually caused by phosphaturic mesenchymal tumours, leading to great distress due to bone pain and affecting quality of life (QoL). This study aimed to investigate the prevalence and clinical outcomes of hip fractures and subchondral insufficiency fractures (SIF) of the femoral head.

Methods

Twelve TIO patients were treated between January 2000 and December 2016 at our hospital. All underwent surgery for the tumour causing TIO, and complete removal of the tumour was accomplished in nine of 12 cases. Plain radiographs of the hip were obtained in all cases, and magnetic resonance imaging (MRI) was obtained from 15 hips representing eight patients before tumour removal. We evaluated the prevalence of hip fractures or SIF and their clinical outcomes.

Results

Hip fractures were observed in six of 12 cases, and the total number of fractures was nine, of which five were femoral neck, two were intertrochanteric and two were subtrochanteric fractures. Conservative treatment, regardless of complete remission of TIO, was successful except in one case with impending subtrochanteric fracture. SIFs were observed in 11 of 24 hips. Seven of 11 hips with SIF showed progression after surgery for tumour resection.

Conclusions

Hip fractures and SIF are highly prevalent in TIO patients. Surgical and medical treatment for TIO is sufficient for treating hip fractures conservatively. However, SIF tends to show progression of femoral head collapse, serving as the main cause of pain after successful TIO treatment.

Available only for authorised users

Fukumoto S (2014) Diagnostic modalities for FGF23-producing tumors in patients with tumor-induced osteomalacia. Endocrinol Metab 29:136–143. https://doi.org/10.3803/EnM.2014.29.2.136 CrossRef

Endo I, Fukumoto S, Ozono K et al (2015) Nationwide survey of fibroblast growth factor 23 (FGF23)-related hypophosphatemic diseases in Japan: prevalence, biochemical data and treatment. Endocr J 62:811–816. https://doi.org/10.1507/endocrj.EJ15-0275 CrossRefPubMed

Jan de Beur SM (2005) Tumor-induced osteomalacia. JAMA 294:1260–1267CrossRefPubMed

Chalmers J, Conacher WD, Gardner DL et al (1967) Osteomalacia--a common disease in elderly women. J Bone Joint Surg Br 49:403–423PubMed

Chalmers J (1970) Subtrochanteric fractures in osteomalacia. J Bone Joint Surg Br 52:509–513PubMed

Yamamoto T, Bullough PG (1999) Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly. Arthritis Rheum 42:2719–2723CrossRefPubMed

Yamamoto T, Iwamoto Y, Schneider R et al (2008) Histopathological prevalence of subchondral insufficiency fracture of the femoral head. Ann Rheum Dis 67:150–153CrossRefPubMed

Vande Berg BC, Malghem J, Goffin EJ et al (1994) Transient epiphyseal lesions in renal transplant recipients: presumed insufficiency stress fractures. Radiology 191:403–407CrossRefPubMed

Yamamoto T (2012) Subchondral insufficiency fractures of the femoral head. Clin Orthop Surg 4:173–180. https://doi.org/10.4055/cios.2012.4.3.173 CrossRefPubMedPubMedCentral

10.

Sonoda K, Yamamoto T, Motomura G et al (2016) Fat-suppressed T2-weighted MRI appearance of subchondral insufficiency fracture of the femoral head. Skelet Radiol 45:1515–1521. https://doi.org/10.1007/s00256-016-2462-z CrossRef

11.

Kobayashi H, Akiyama T, Okuma T et al (2017) Three-dimensional fluoroscopic navigation-assisted surgery for tumors in patients with tumor-induced osteomalacia in the bones. Comput Assist Surg 22:14–19. https://doi.org/10.1080/24699322.2017 CrossRef

12.

Sun ZJ, Jin J, Qiu GX et al (2015) Surgical treatment of tumor-induced osteomalacia: a retrospective review of 40 cases with extremity tumors. BMC Musculoskelet Disord 16:43. https://doi.org/10.1186/s12891-015-0496-3 CrossRefPubMedPubMedCentral

13.

Jiang Y, Xia WB, Xing XP et al (2012) Tumor-induced osteomalacia: an important cause of adult-onset hypophosphatemic osteomalacia in China: report of 39 cases and review of the literature. J Bone Miner Res 27:1967–1975. https://doi.org/10.1002/jbmr.1642 CrossRefPubMed

14.

Chouhan V, Agrawal K, Vinothkumar TK et al (2010) Bilateral insufficiency fracture of the femoral head and neck in a case of oncogenic osteomalacia. J Bone Joint Surg Br 92:1028–1031. https://doi.org/10.1302/0301-620X.92B7.24526 CrossRefPubMed

15.

Lee YS, Kim BK, Lee HJ et al (2016) Pathologic femoral neck fracture due to Fanconi syndrome induced by adefovir dipivoxil therapy for hepatitis B. Clin Orthop Surg 8:232–236. https://doi.org/10.4055/cios.2016.8.2.232 CrossRefPubMedPubMedCentral

16.

Riaz S, Alam M, Umer M (2006) Frequency of osteomalacia in elderly patients with hip fractures. J Pak Med Assoc 56:273–276PubMed

17.

Imel EA, Zhang X, Ruppe MD et al (2015) (2015) prolonged correction of serum phosphorus in adults with X-linked Hypophosphatemia using monthly doses of KRN23. J Clin Endocrinol Metab 100(7):2565–2573. https://doi.org/10.1210/jc.2015-1551 CrossRefPubMedPubMedCentral

18.

Tatsumi F, Horiya M, Tanabe A et al (2016) Dramatic mitigation of bone pain after phosphorus replacement therapy in a subject with FGF23-related hypophosphatemic osteomalacia. Spring 5:1904. https://doi.org/10.1186/s40064-016-3602-6 CrossRef

19.

Iwasaki K, Yamamoto T, Nakashima Y et al (2009) Subchondral insufficiency fracture of the femoral head after liver transplantation. Skelet Radiol 38:925–928. https://doi.org/10.1007/s00256-009-0706-x CrossRef

20.

Hackney LA, Lee MH, Joseph GB et al (2016) Subchondral insufficiency fractures of the femoral head: associated imaging findings and predictors of clinical progression. Eur Radiol 26:1929–1941. https://doi.org/10.1007/s00330-015-3967-x CrossRefPubMed

Title: Prevalence and clinical outcomes of hip fractures and subchondral insufficiency fractures of the femoral head in patients with tumour-induced osteomalacia
Authors: Hiroshi Kobayashi
Nobuaki Ito
Toru Akiyama
Tomotake Okuma
Yuka Kinoshita
Masachika Ikegami
Yusuke Shinoda
Seiji Fukumoto
Sakae Tanaka
Hirotaka Kawano
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 12/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3610-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prevalence and clinical outcomes of hip fractures and subchondral insufficiency fractures of the femoral head in patients with tumour-induced osteomalacia

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2017

Age and dressing type as independent predictors of post-operative infection in patients with acute compartment syndrome of the lower leg

Pediatric Orthopaedics - from Kirschner wires to titanium

Biomechanical evaluation of distal biceps tendon repair using tension slide technique and knotless fixation technique

Posterior only approach for fifth lumbar corpectomy: indications and technical notes

Patient sexual function and hip replacement surgery: A survey of surgeon attitudes

Injuries of the spine and of the spinal cord in the Hippocratic Corpus of medicine