PMID- 24706031
OWN - NLM
STAT- MEDLINE
DCOM- 20141223
LR  - 20220317
IS  - 1432-0827 (Electronic)
IS  - 0171-967X (Linking)
VI  - 94
IP  - 6
DP  - 2014 Jun
TI  - Fibroblast growth factor 23 is elevated in tenofovir-related hypophosphatemia.
PG  - 665-8
LID - 10.1007/s00223-014-9854-7 [doi]
AB  - In human immunodeficiency virus (HIV)-infected patients, tenofovir disoproxil 
      fumarate (TDF) may cause hypophosphatemia leading to osteomalacia due to renal 
      phosphate wasting. Fibroblast growth factor 23 (FGF23) may play a role in this 
      setting. We present an HIV-infected patient with TDF-induced profound 
      hypophosphatemia, Fanconi syndrome, osteomalacia, and bilateral hip fracture. 
      Routine serum biochemistry was assessed by standard methods. The plasma FGF23 
      concentration was measured at Mayo Laboratories (Scottsdale, AZ, USA). Bone 
      mineral density (BMD) was measured using a Hologic Discovery densitometer. At 
      presentation, the patient's plasma C-terminal FGF23 was 2,760 reference units 
      (RU)/mL (15 times upper limit of normal; reference interval [RI] </= 180 RU/mL), 
      serum phosphate was 0.58 (RI 0.8-1.6 mmol/L), and TmPO4/GFR was 95%. DXA at the 
      lumbar spine showed a Z score of -4.0. Vitamin D3 and oral phosphate were 
      administered, and TDF was discontinued. After 4 months off TDF, lumbar spine BMD 
      significantly increased by 12% (Z score -3.5); by 6 months the plasma C-terminal 
      FGF23 declined to 1.8 times the upper limit of normal, and both urine and serum 
      phosphate levels normalized. By its marked elevation and subsequent near 
      normalization, FGF23 may be responsible for a component of the phosphate wasting 
      syndrome in these patients. The time course of resolution was 6 months. As 
      expected, with calcium, vitamin D, and phosphate management, BMD significantly 
      improved with resolution of osteomalacia. Clinicians should be aware of this side 
      effect of TDF and the time course of its resolution.
FAU - Saeedi, Ramesh
AU  - Saeedi R
AD  - Department of Pathology and Laboratory Medicine, University of British Columbia, 
      Vancouver, BC, Canada.
FAU - Jiang, Shi Yuan
AU  - Jiang SY
FAU - Holmes, Daniel T
AU  - Holmes DT
FAU - Kendler, David L
AU  - Kendler DL
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20140405
PL  - United States
TA  - Calcif Tissue Int
JT  - Calcified tissue international
JID - 7905481
RN  - 0 (Anti-HIV Agents)
RN  - 0 (FGF23 protein, human)
RN  - 0 (Organophosphonates)
RN  - 62031-54-3 (Fibroblast Growth Factors)
RN  - 7Q7P4S7RRE (Fibroblast Growth Factor-23)
RN  - 99YXE507IL (Tenofovir)
RN  - JAC85A2161 (Adenine)
SB  - IM
MH  - Adenine/adverse effects/*analogs & derivatives
MH  - Adult
MH  - Anti-HIV Agents/*adverse effects
MH  - Bone Density
MH  - Fanconi Syndrome/chemically induced
MH  - Fibroblast Growth Factor-23
MH  - Fibroblast Growth Factors/*blood
MH  - HIV Infections/*drug therapy
MH  - Humans
MH  - Hypophosphatemia/*chemically induced/complications
MH  - Male
MH  - Organophosphonates/*adverse effects
MH  - Osteomalacia/chemically induced
MH  - Osteoporosis/*blood/etiology
MH  - Tenofovir
EDAT- 2014/04/08 06:00
MHDA- 2014/12/24 06:00
CRDT- 2014/04/08 06:00
PHST- 2014/01/09 00:00 [received]
PHST- 2014/03/18 00:00 [accepted]
PHST- 2014/04/08 06:00 [entrez]
PHST- 2014/04/08 06:00 [pubmed]
PHST- 2014/12/24 06:00 [medline]
AID - 10.1007/s00223-014-9854-7 [doi]
PST - ppublish
SO  - Calcif Tissue Int. 2014 Jun;94(6):665-8. doi: 10.1007/s00223-014-9854-7. Epub 
      2014 Apr 5.