Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

Tanaka, Motoyuki; Setoguchi, Takao; Ishidou, Yasuhiro; Arishima, Yoshiya; Hirotsu, Masataka; Saitoh, Yoshinobu; Nakamura, Shunsuke; Kakoi, Hironori; Nagano, Satoshi; Yokouchi, Masahiro; Kamizono, Junichi; Komiya, Setsuro

doi:10.1186/1746-1596-7-108

Cited by 18 publications

(22 citation statements)

References 27 publications

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“…Nephrotoxicity associated with high-dose ADV typically has a late onset ([6 months) [15]. The time to onset of low-dose ADV-induced FS, based on case reports, ranges from a few months to [5 years [4][5][6][7][8][9][10][11][12]. In our patient, it took more than 2 years before the tubulopathy became apparent.…”

Section: Discussionmentioning

confidence: 99%

“…From the series of case reports so far, the time to resolution after cessation of ADV ranged from a few weeks to months [4][5][6][7][8][9][10][11][12]. A previous trial with high-dose ADV treatment showed a median time to resolution of renal dysfunction of 15 weeks, with the nephrotoxicity failing to resolve completely at 41 weeks after onset in 16 % of the patients [15].…”

Section: Discussionmentioning

confidence: 99%

“…The first report of ADV-associated hypophosphatemic osteomalacia was published in 2008 [4], with a number of reported cases of ADV-induced FS [5][6][7][8][9][10][11][12] since then. Most of the cases published were in East Asian subjects, which may either suggest a racial predilection, or an indication of the increased prevalence of hepatitis B infection requiring ADV treatment in East Asia.…”

Section: Discussionmentioning

confidence: 99%

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Adefovir-induced Fanconi syndrome: diagnostic pearls and perils of late or missed diagnosis

et al. 2014

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Low-dose adefovir therapy has been increasingly recognised as a cause of Fanconi syndrome. Being relatively novel, early diagnosis is both fraught with difficulty and yet of paramount importance given its farreaching consequences, many of which are amenable to treatment. We discuss a patient who presented with hypokalemia and other electrolyte abnormalities suggestive of Fanconi syndrome whilst on adefovir for hepatitis B. A trans-tubular potassium gradient (TTKG = 9.4) and urinary fractional phosphate excretion (39.4 %) consistent with renal potassium and phosphate wasting together with euglycemic glycosuria, aminoaciduria and hypophosphatemic osteomalacia supported the diagnosis of adefovirinduced Fanconi syndrome. With the cessation of the culprit drug, the patient has achieved partial recovery after 9 months. A high index of suspicion coupled with regular symptom surveillance and electrolyte monitoring is recommended in the course of adefovir therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Adefovir-induced Fanconi syndrome: diagnostic pearls and perils of late or missed diagnosis

et al. 2014

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“…Previously, Tanaka and colleagues [18] reported a 62-year-old man that developed pathological femoral fractures due to osteomalacia after 5 years from the beginning of adefovir, without deficiency of vitamin D.…”

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confidence: 99%

Adefovir dipivoxil-induced development of osteomalacia and Fanconi syndrome during the treatment of hepatitis B virus (HBV)-related cirrhosis

Staltari¹,

Caroleo

Michniewicz

et al. 2014

CMI

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A 55-year-old man (height = 175 cm, weight = 68 kg, Body Mass Index = 22.2 kg/ m 2 ) came to our observation in December 2012 due to the onset of bone pain, muscle cramps, and asthenia. Past history revealed that about 24 years before (1988) a chronic hepatitis B (anti-HBe positive) infection was diagnosed and 15 years later (2003) liver biopsy and endoscopy documented the presence of cirrhosis (Child 5A) with esophageal varices, respectively.On 2005, a treatment with pegylated interferon (180 µg/week subcutaneously) was started (HBV-DNA = 10,000,000 IU/ml), but 18 months later (February 2007) for the persistence of high HBV-DNA levels (HBV-DNA = 352,000 IU/ml), pegylat- Why we describe this caseNotwithstanding adefovir is considered safe at the dosage of 10 mg/day, renal function must be carefully evaluated in order to prevent systemic disease and bone fracture. This case report could be useful in order to perform an appropriate prescription in HBV patients treated with adefovir and a risk of kidney or bone disease (e.g. patients taking non steroidal antinflammatory drugs, aminoglycosides, corticosteroids or menopausal women) ed-interferon was stopped and lamivudine (100 mg/day) was administered. During the follow-up, three months later ( Rate before adefovir = 78.26 ml/min/1.73 m 2 ; during adefovir treatment = 57.38 ml/min/1.73 m 2 ) Abstract Adefovir dipivoxil is a nucleotide analog reverse transcriptase inhibitor used to treat adult patients affected by HBeAg-positive and HBeAg-negative chronic hepatitis B and with clinical evidence of lamivudine-resistant hepatitis B virus (HBV). Adefovir administered at a dosage of 10 mg/day is generally well tolerated, even if renal toxicity, type Fanconi syndrome, was reported during long-term treatments. We report a case of osteomalacia with Fanconi syndrome and pathologic fracture of the femur related to long-time (67 months) adefovir treatment (10 mg/day) in a patient with compensated hepatitis B virus (HBV) cirrhosis (Child 5A) and with a previous normal renal function (estimated Glomerular Filtration . The patient was switched to entecavir at a dose of 1 mg/day, with both suppression of viremia and improvement of osteomalacia and Fanconi syndrome; the patient's follow-up is still ongoing after 22 months. Sviluppo di osteomalacia e di sindrome di Fanconi durante il trattamento con adefovir in un paziente affetto da cirrosi epatica HBV-correlataCMI 2014; 8(4): 109-114 http://dx.doi.org/10.7175/cmi.v8i4.969 1 Rete Regionale di informazione sul farmaco,

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“…While adefovir dipivoxil (ADV) effectively suppresses the hepatitis B virus, it can cause proximal renal tubular dysfunction leading to phosphate wasting [1,2]. The safety of low-dose ADV (a dose of 10 mg/day), which does not induce clinically significant nephrotoxicity, is well recognized, but a few cases of hypophosphatemic osteomalacia (HO) caused by low-dose ADV therapy have recently been reported [3][4][5][6].…”

mentioning

confidence: 99%

Low-Dose Adefovir-Induced Hypophosphatemic Osteomalacia on Whole-Body Bone Scintigraphy

Kim

Won

Song

et al. 2013

Nucl Med Mol Imaging

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Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

Cited by 18 publications

References 27 publications

Adefovir-induced Fanconi syndrome: diagnostic pearls and perils of late or missed diagnosis

Adefovir-induced Fanconi syndrome: diagnostic pearls and perils of late or missed diagnosis

Adefovir dipivoxil-induced development of osteomalacia and Fanconi syndrome during the treatment of hepatitis B virus (HBV)-related cirrhosis

Low-Dose Adefovir-Induced Hypophosphatemic Osteomalacia on Whole-Body Bone Scintigraphy

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