Shift in Calcium From Peripheral Bone to Axial Bone After Tumor Resection in Patients With Tumor-Induced Osteomalacia

定量计算机断层扫描 医学 骨矿物 股骨颈 骨软化症 胫骨 泌尿科 成纤维细胞生长因子23 骨密度 骨质疏松症 内科学 核医学 甲状旁腺激素 外科
作者
Xiaolin Ni,Z Zhang,Wenmin Guan,Yue Chi,Xiang Li,Yiyi Gong,Qi Pang,Yu Wang,Huanwen Wu,Li Huo,Yong Liu,Jin Jin,Xi Zhou,Wei Lv,Lian Zhou,Xia Yu,W. Liu,Ruizhi Jiajue,Lijia Cui,Ou Wang,Mei Li,Xiaoping Xing,Yan Jiang,Weibo Xia
出处
期刊:The Journal of Clinical Endocrinology and Metabolism [Oxford University Press]
卷期号:108 (11): e1365-e1373 被引量:4
标识
DOI:10.1210/clinem/dgad252
摘要

Abstract Context Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by excessive production of fibroblast growth factor 23 (FGF23) by a tumor. After successful tumor resection, patients can recover from hypophosphatemia quicky. However, data on the changes in bone mineral density (BMD) and microstructure in the short term after surgery remained unclear. Objective This work aimed to investigate the postoperative changes in BMD and microstructure both in peripheral and axial bone in TIO patients. Methods We evaluated BMD and microarchitecture in 22 TIO patients using high-resolution peripheral quantitative computed tomography (HR-pQCT) and dual-energy x-ray absorptiometry (DXA) before and 3 months after surgery in this retrospective study. Results In this study, a total of 22 TIO patients who had recovered serum phosphate levels postoperatively were enrolled. After surgery, areal BMD (aBMD) increased by 21.6% in the femoral neck, by 18.9% in the total hip, and by 29.5% in the lumbar spine. Moreover, TBS increased by 14.1% (all P < .001). In contrast, trabecular or cortical volumetric BMD (vBMD), and microstructure of trabecular bone (trabecular number, separation and bone volume ratio) and cortical bone (cortical thickness and porosity) at the distal radius or tibia were further deteriorated. Correlation analyses found that changes in femoral neck and total hip aBMD were both conversely associated with changes in trabecular vBMD and bone volume ratio, while positively correlated with change in trabecular separation at the distal radius. Conclusion Although aBMD and microstructure in the axial bone were improved, vBMD and microstructure in the peripheral bone were further impaired shortly after surgery. Correlation of improvement of aBMD in the total hip and femoral neck with deterioration of vBMD and microstructure at the distal radius indicated a shift in calcium from the peripheral bone to the axial bone in the short term after tumor resection in TIO patients.
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