Archives of Osteoporosis最新文献

{"title":"The use of the FRAX® tool and its adjustments in women living with diabetes: a cohort study in primary care in Brazil","authors":"Fernando Meireles de Oliveira,&nbsp;Rafaela Martinez Copês Leal,&nbsp;Fabio Vasconcellos Comim,&nbsp;Melissa Orlandin Premaor","doi":"10.1007/s11657-024-01489-x","DOIUrl":"10.1007/s11657-024-01489-x","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>The FRAX® algorithm showed good accuracy in women living with DM followed in primary care. There were no differences between the ROC curve with and without adjustments for major and hip fractures. The FRAX® 10-year and FRAX® AR were better calibrated in this population.</p><h3>Purpose</h3><p>An increased risk of fractures in people living with diabetes has been described. Screening instruments to calculate this risk have been proposed, including the FRAX® algorithm. Some studies suggest that minor modifications to this instrument can improve its performance. These modifications work well in other countries, but we do not know if they work in Brazil. The objective of our study was to evaluate the performance of the FRAX® algorithm with and without adjustments for women living with DM (WLDM) in primary care in Brazil.</p><h3>Methods</h3><p>A cohort study that included post-menopausal women attending primary care in Santa Maria, Brazil, was conducted from 2013 to 2018. The risk for major and hip fractures was calculated using the FRAX® tool. The FRAX® risk was calculated: (1) without adjustments (unadjusted FRAX®); (2) increasing the entered age by 10 years in individuals with DM (FRAX® 10 years); and (3) inserting the diagnosis of DM as rheumatoid arthritis (FRAX® AR).</p><h3>Results</h3><p>The accuracy for major fracture was 0.948 (unadjusted FRAX®), 0.947 (FRAX® 10 years), and 0.946 (FRAX® AR). For hip fractures, the accuracies were 0.989 (unadjusted FRAX®), 0.988 (FRAX® 10 years), and 0.988 (FRAX® AR). Furthermore, there were no differences between the area under the ROC curve with and without adjustments for major and hip fractures. Conversely, the FRAX® 10 years and the FRAX® AR were better calibrated, presenting a lower Chi-square.</p><h3>Conclusion</h3><p>The FRAX® algorithm showed good accuracy in WLDM followed in primary care. The FRAX® 10 years and FRAX® AR were better calibrated in this population.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"20 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare association between ankylosing spondylitis and paget’s disease: A case of pagetic vertebral ankylosis","authors":"Celil Barlas Cengiz,&nbsp;Melih Kızıltepe,&nbsp;Hüseyin Kaplan,&nbsp;Emel Oğuz Kökoğlu,&nbsp;Tuğba Kahraman Denizhan,&nbsp;Abdurrahman Soner Şenel","doi":"10.1007/s11657-024-01490-4","DOIUrl":"10.1007/s11657-024-01490-4","url":null,"abstract":"<div><p>Paget’s disease is a condition marked by abnormal bone remodeling, involving both excessive bone formation and destruction, predominantly in the elderly. Pagetic vertebral ankylosis is a rare manifestation, often associated with Paget’s disease, ankylosing spondylitis, or diffuse idiopathic skeletal hyperostosis. This form of acquired vertebral ankylosis is uncommon and occurs in cases with bone-bridging syndesmophytes or osteophytes. Here, we present a case of delayed diagnosis of Paget’s disease in the lower vertebral column, progressing to cervicothoracic vertebral ankylosis secondary to ankylosing spondylitis.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"20 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142889495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of excluding fractured or abnormal vertebrae on the trabecular bone score measurement","authors":"Yen-Huai Lin,&nbsp;Michael Mu Huo Teng","doi":"10.1007/s11657-024-01485-1","DOIUrl":"10.1007/s11657-024-01485-1","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>Brief rationale: The use of L1–L4 vertebrae, without exclusions, has been recommended for trabecular bone score (TBS) measurements.</p><p>Main result: Excluding abnormal and fractured vertebrae affected the TBS.</p><p>Significance of the paper: Fracture or degenerative abnormality may not affect TBS. The preferred action may involve including all levels without exclusions.</p><h3>Purpose</h3><p>The use of L1–L4 vertebrae, without exclusions, has been recommended for trabecular bone score (TBS) measurements. We aimed to investigate the effect of excluding fractured or abnormal vertebrae from TBS.</p><h3>Methods</h3><p>Dual-energy X-ray absorptiometry images of 2767 participants, including 1080 without excluded vertebrae, 556 with fractured vertebrae, and 1131 with abnormal vertebrae showing a 1.0 T-score difference compared to the adjacent vertebrae, were retrospectively reviewed. Differences between TBS measurements with and without fractured or abnormal vertebrae were evaluated.</p><h3>Results</h3><p>Among 1080 participants without excluded vertebrae, TBS was 1.234 at L1, 1.296 at L2, 1.308 at L3, and 1.301 at L4. A significantly higher mean TBS was seen after excluding L1, whereas a significantly lower mean TBS was seen after excluding L2–L4. In the 556 participants with fractured vertebrae, excluding the involved level from the TBS calculation led to a significant difference in the total sample, women, ≥ 70 years old, and overweight subgroups. A significantly higher mean TBS was seen after excluding the fractured L1, whereas a significantly lower mean TBS was seen after excluding fractures at L2–L4. Among the 1131 participants with abnormal vertebrae, excluding the involved level from the TBS led to a significant difference in age, sex, and body mass index subgroups. Excluding abnormal L1 and L4 vertebrae led to a significantly higher and lower mean TBS, respectively.</p><h3>Conclusion</h3><p>Excluding fractured or abnormal vertebrae led to differences in TBS across various subgroups. Regarding the effect of vertebral level exclusion, the observed differences may be attributed to the systematic intervertebral variation, which is unrelated to any effect from fractures or degenerative abnormalities.\u0000</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"20 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-024-01485-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of 12-week power training on bone in mobility-limited older adults: randomised controlled trial","authors":"Valentina Muollo,&nbsp;Lars G. Hvid,&nbsp;Vikram V. Shanbhogue,&nbsp;Viktoria Steinhauser,&nbsp;Daniela Caporossi,&nbsp;Ivan Dimauro,&nbsp;Marianne Skovsager Andersen,&nbsp;Cristina Fantini,&nbsp;Elisa Grazioli,&nbsp;Elsa S. Strotmeyer,&nbsp;Paolo Caserotti","doi":"10.1007/s11657-024-01487-z","DOIUrl":"10.1007/s11657-024-01487-z","url":null,"abstract":"<div><h3>Summary</h3><p>This study examines how power training affects estimated bone strength, revealing that females benefit more than males, especially in the upper limbs (radius). These findings highlight the importance of designing sex-specific exercise programs to enhance bone health. Further research is needed to optimize training duration and address site-specific differences.</p><h3>Purpose</h3><p>This study aimed to compare the effects of 12-week of power training (PWT), an explosive form of strength training, on bone microarchitecture, estimated bone strength, and markers in mobility-limited (gait speed &lt; 0.9 m/s) older adults.</p><h3>Methods</h3><p>Fifty-seven older adults (83 ± 5 years) were randomly assigned to either a training group (TRAIN, <i>n</i> = 28, 15 females, 13 males) performing high-intensity PWT or a control group (CTRL, <i>n</i> = 29, 22 females, 7 males) maintaining their usual lifestyle. High-resolution peripheral quantitative computed tomography (HR-pQCT) assessed bone geometry, densities, microarchitecture (e.g. trabecular number (Tb.N) and thickness (Tb.Th)), and estimated bone strength (stiffness and failure load) at the tibia and radius. Blood markers for bone metabolism (PINP and CTX-1) and muscle strength (handgrip and leg press) were also measured.</p><h3>Results</h3><p>Baseline sex differences showed females having lower stiffness (− 37.5%) and failure load (− 38%) at the radius compared with males. After PWT, females in the TRAIN group exhibited declines in Tb.N (− 4.4%) and improvements in Tb.Th (+ 6.0%), stiffness (+ 2.7%), and failure load (+ 2.4%) at the radius (<i>p</i> &lt; 0.05). A time x group interaction indicated increases in leg press strength for the whole TRAIN group (+ 23%), and within females (+ 29%) and males (+ 19%) (<i>p</i> &lt; 0.001). Baseline handgrip strength correlated with stiffness (<i>r</i> = 0.577) and failure load (<i>r</i> = 0.612) at the radius (<i>p</i> &lt; 0.001). Females in the TRAIN group showed a reduction in PINP (− 25%), while males showed an increase in CTX-1 (+ 18%).</p><h3>Conclusion</h3><p>A 12-week PWT may enhance estimated bone strength in mobility-limited older adults, especially at sites less accustomed to daily loading (i.e. radius).</p><h3>Clinical trial registration</h3><p>NCT02051725.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"20 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of isoflavone interventions on bone turnover markers and factors regulating bone metabolism in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials","authors":"Ratchanon Inpan,&nbsp;Nahathai Dukaew,&nbsp;Mingkwan Na Takuathung,&nbsp;Supanimit Teekachunhatean,&nbsp;Nut Koonrungsesomboon","doi":"10.1007/s11657-024-01467-3","DOIUrl":"10.1007/s11657-024-01467-3","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>This study examined how isoflavone interventions impact bone health in postmenopausal women. Analyzing 73 trials found that isoflavones reduce bone resorption markers, enhance bone minerals, and increase hormones regulating bone metabolism. This suggests that isoflavones could help address bone health issues in postmenopausal women.</p><h3>Purpose</h3><p>This study aimed to assess the impact of isoflavone interventions on bone turnover markers and various biochemical markers of bone metabolism through systematic review and meta-analysis.</p><h3>Methods</h3><p>Four electronic databases, including PubMed, Embase, Scopus, and Cochrane Library, were searched in September 2023 for investigating the effects of isoflavones on bone turnover markers as well as signaling molecules regulating osteoclast differentiation, bone minerals, and hormones regulating bone metabolism in postmenopausal women. The main effect estimates, obtained using a random-effects model, were summarized using the mean difference (MD) or standardized mean difference (SMD), as appropriate.</p><h3>Results</h3><p>A total of 73 randomized controlled trials were included, comparing an isoflavone intervention to a placebo. Our findings demonstrated that isoflavone interventions significantly reduced bone resorption markers, that is, β cross-linked C-telopeptide of type 1 collagen (β-CrossLaps) (MD = − 0.0943 ng/mL; <i>P</i> = 0.0071) and pyridinoline (PYD) (SMD = − 0.9111; <i>P</i> = 0.0247). Moreover, isoflavone interventions positively affected bone mineral parameters by increasing serum calcium levels (MD = 0.3430 mg/dL; <i>P</i> = 0.0267) and decreasing serum phosphorus levels (MD = − 0.0648 mg/dL; <i>P</i> = 0.0435). Hormones involved in regulating bone metabolism, particularly insulin-like growth factor type 1 (IGF-1), exhibited significant increases following isoflavone interventions (MD = 9.8163 ng/mL; <i>P</i> &lt; 0.0001). Subgroup analysis suggested that the effects of isoflavones on bone turnover markers are influenced by factors such as the duration since menopause and the intervention duration.</p><h3>Conclusion</h3><p>This systematic review and meta-analysis highlight the potential of isoflavone interventions to rectify imbalances in bone remodeling, enhance bone mineral homeostasis, and optimize hormones regulating bone metabolism in postmenopausal women.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"20 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142859801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Acquired hypophosphatemic osteomalacia: case series from a Peruvian referral center (1999–2023)","authors":"José Paz-Ibarra,&nbsp;Sofía Sáenz-Bustamante,&nbsp;Manuel Inostroza-Fernández,&nbsp;Paola Sifuentes Hermenegildo,&nbsp;Liliana Ancajima Lescano,&nbsp;Marcio Concepción-Zavaleta,&nbsp;Alejandro Román-González,&nbsp;Alfredo Adolfo Reza-Albarrán","doi":"10.1007/s11657-024-01481-5","DOIUrl":"10.1007/s11657-024-01481-5","url":null,"abstract":"","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"20 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142778593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Bilateral lumbar pedicle fracture in a patient receiving long-term bisphosphonate therapy: a case report with pathological evaluation","authors":"Ryo Fujita,&nbsp;Kota Suda,&nbsp;Zen-Ichi Tanei,&nbsp;Satoko Matsumoto Harmon,&nbsp;Miki Komatsu,&nbsp;Keiichi Nakai,&nbsp;Kento Inomata,&nbsp;Shin Matsushima,&nbsp;Tsutomu Endo,&nbsp;Katsuhisa Yamada,&nbsp;Masahiko Takahata,&nbsp;Norimasa Iwasaki","doi":"10.1007/s11657-024-01477-1","DOIUrl":"10.1007/s11657-024-01477-1","url":null,"abstract":"","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"19 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of weekly liquid alendronate in Korean postmenopausal women with osteoporosis: a 12-month, multi-center, randomized trial","authors":"Seungjin Baek,&nbsp;Seong Hee Ahn,&nbsp;Namki Hong,&nbsp;Da Hea Seo,&nbsp;Seongbin Hong,&nbsp;Yumie Rhee","doi":"10.1007/s11657-024-01480-6","DOIUrl":"10.1007/s11657-024-01480-6","url":null,"abstract":"<div><h3>\u0000 <i>Summary</i>\u0000 </h3><p>This study compared liquid and tablet forms of alendronate for osteoporosis treatment. After 12 months, both forms increased bone density to a similar degree with no significant differences in side effects. New low-volume liquid alendronate is as effective as tablets, offering an alternative treatment option for postmenopausal women with osteoporosis.</p><h3>Purpose/Introduction</h3><p>Alendronate, despite its significant efficacy, poses challenges due to complex administration protocols and patient compliance issues, underscoring the need for various formulations. This study compared the efficacy and safety of once-weekly low-volume liquid alendronate sodium trihydrate (ALN-S), an oral solution, to once-weekly alendronate sodium (ALN-T), an oral tablet, in Korean postmenopausal women with osteoporosis.</p><h3>Methods</h3><p>In a 12-month, multi-center, prospective, randomized, open-labeled, parallel trial conducted at two hospitals in Korea, 170 patients were randomized to alendronate solution (ALN-S) (<i>N</i> = 85) or alendronate tablet (ALN-T) (<i>N</i> = 85) groups. The bone mineral density (BMD) of the lumbar spine (LS), femoral neck (FN), and total hip (TH) was measured at baseline and after 12 months. Bone turnover markers (BTMs) were assessed at baseline, 6, and 12 months. The primary outcome was the percentage change in BMD of the LS, evaluated for non-inferiority.</p><h3>Results</h3><p>After 12 months, both ALN-S and ALN-T groups exhibited a significant increase in LS, FN, and TH BMD, with no significant intergroup differences (ALN-S: LS 5.0 ± 0.6%, FN 1.8 ± 0.6%, TH 2.2 ± 0.5%; ALN-T: LS 5.2 ± 0.6%, FN 1.6 ± 0.6%, TH 1.8 ± 0.5%). ALN-S was found to be non-inferior to ALN-T for BMD change at LS (treatment difference: − 0.22%, 95% CI: − 1.84 to 1.40%), excluding the predefined non-inferiority margin of − 2.29%. Changes in BTMs did not differ significantly between groups. The frequency of adverse events was similar between groups.</p><h3>Conclusion</h3><p>Liquid alendronate was non-inferior to tablet alendronate in increasing BMD in Korean postmenopausal women with osteoporosis, presenting a viable alternative when the tablet form is limited in various clinical scenarios.</p><h3>Clinical trial registration</h3><p>The trial was registered with ClinicalTrials.gov (NCT05387200).</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"19 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-024-01480-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142714337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Efficacy and safety of teriparatide vs. bisphosphonates and denosumab vs. bisphosphonates in osteoporosis not previously treated with bisphosphonates: a systematic review and meta-analysis of randomized controlled trials","authors":"Mingnian Li,&nbsp;Zhuoqi Ge,&nbsp;Benqi Zhang,&nbsp;Li Sun,&nbsp;Zhongyuan Wang,&nbsp;Tao Zou,&nbsp;Qi Chen","doi":"10.1007/s11657-024-01478-0","DOIUrl":"10.1007/s11657-024-01478-0","url":null,"abstract":"","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"19 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s11657-024-01478-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142679829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acquired hypophosphatemic osteomalacia: case series from a Peruvian referral center (1999–2023)","authors":"José Paz-Ibarra,&nbsp;Sofía Sáenz-Bustamante,&nbsp;Manuel Inostroza-Fernández,&nbsp;Paola Sifuentes Hermenegildo,&nbsp;Liliana Ancajima Lescano,&nbsp;Marcio Concepción-Zavaleta,&nbsp;Alejandro Román-González,&nbsp;Alfredo Adolfo Reza-Albarrán","doi":"10.1007/s11657-024-01476-2","DOIUrl":"10.1007/s11657-024-01476-2","url":null,"abstract":"<div><h3>Background</h3><p>Acquired hypophosphatemic osteomalacia (AHO) is a rare metabolic bone disorder characterized by hypophosphatemia and impaired bone mineralization. Tumor-induced osteomalacia (TIO) is the most common cause of AHO, caused by phosphaturic tumors that overproduce fibroblast growth factor 23 (FGF-23).</p><h3>Objective</h3><p>To present the clinical characteristics, diagnostic challenges, and outcomes of seven cases of AHO in Peruvian patients between 1999 and 2023.</p><h3>Methods</h3><p>A retrospective review of seven patients diagnosed with AHO was conducted. Clinical data, including diagnostic procedures, treatments, and outcomes, were collected.</p><h3>Results</h3><p>Seven cases of AHO were reviewed. In case one, osteomalacia did not improve despite supraphysiological doses of vitamin D (ergocalciferol/cholecalciferol), and no tumor was detected with available tests, resulting in the patient’s death. Cases two and three involved tumors located in the right leg and right hemithorax, respectively, with symptom resolution following total resection. In cases four, five, and seven, exhaustive exams failed to locate tumors. Cases four, six, and seven showed elevated FGF-23 levels, while case five had inappropriately normal FGF-23 levels. Case seven was the first patient in Peru to receive burosumab treatment. In case six, a tumor in the head of the femur was identified, but the patient opted for nonsurgical management.</p><h3>Conclusion</h3><p>The diagnosis of AHO is challenging, requiring a high index of clinical suspicion and biochemical confirmation. TIO is the most common cause of AHO, emphasizing the importance of locating the phosphaturic tumor. However, in some cases, the tumor remains elusive despite exhaustive diagnostic workups. This is particularly challenging in developing countries like Peru, where resources are limited.</p></div>","PeriodicalId":8283,"journal":{"name":"Archives of Osteoporosis","volume":"19 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}