Symptomatic hypophosphataemic osteomalacia secondary to the treatment with iron carboxymaltose detected in bone scintigraphy

Gironés, E. Goñi; Salazar, Alicia Camarero; Estébanez, C; Martínez, Mathias

doi:10.1016/j.remnie.2016.09.002

Cited by 10 publications

(39 citation statements)

References 8 publications

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“…If hypophosphatemia is severe, potential complications include respiratory failure, rhabdomyolysis, haemolysis and left ventricular dysfunction . Additionally, an increasing number of published case reports have shown that prolonged hypophosphatemia can result in osteomalacia …”

Section: Introductionmentioning

confidence: 99%

“…26 Additionally, an increasing number of published case reports have shown that prolonged hypophosphatemia can result in osteomalacia. [9][10][11][12][27][28][29][30][31][32][33] The aim of this study was to investigate the rate of hypophosphatemia after infusion of a single dose of intravenous iron (1000 mg) in adults with IBD treated with either ferric carboxymaltose or iron isomaltoside.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of hypophosphatemia in patients with inflammatory bowel disease treated with ferric carboxymaltose or iron isomaltoside

Detlie

Lindstrøm

Jahnsen

et al. 2019

Aliment Pharmacol Ther

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Summary Background Iron deficiency and iron deficiency anaemia are common complications in inflammatory bowel disease (IBD). In patients with moderate‐to‐severe anaemia, oral iron intolerance or ineffectiveness of oral iron, ferric carboxymaltose and iron isomaltoside are widely used. Hypophosphatemia is a side effect of both preparations. Aims To investigate the occurrence of hypophosphatemia in IBD patients with iron deficiency/iron deficiency anaemia treated with high‐dose intravenous iron. Methods A prospective observational study of adult IBD patients with iron deficiency/iron deficiency anaemia was conducted at two study sites where patients received 1000 mg of ferric carboxymaltose or iron isomaltoside. At baseline, weeks 2 and 6, blood and faecal samples were collected. The primary endpoint was to determine the incidence of moderate‐to‐severe hypophosphatemia. Secondary endpoints included the total incidence of hypophosphatemia, possible risk factors for hypophosphatemia, and response to single‐dose intravenous iron. Results One hundred and thirty patients were included. In the per‐protocol set, 52 patients received ferric carboxymaltose and 54 patients received iron isomaltoside. Ferric carboxymaltose treatment had a significantly higher incidence of moderate‐to‐severe hypophosphatemia compared with iron isomaltoside at week 2 (56.9% vs 5.7%, P < 0.001) and a higher incidence at week 6 (13.7% vs 1.9%, P = 0.054).The overall incidence of hypophosphatemia was significantly higher with ferric carboxymaltose compared with iron isomaltoside treatment at weeks 2 (72.5% vs 11.3%, P < 0.001) and 6 (21.6% vs 3.7%, P = 0.013). Conclusions In IBD patients with iron deficiency/iron deficiency anaemia, ferric carboxymaltose was associated with higher incidence, severity and persistence of hypophosphatemia compared with iron isomaltoside. The presence of moderate‐to‐severe hypophosphatemia beyond 6 weeks is a clinical concern that requires further investigation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence of hypophosphatemia in patients with inflammatory bowel disease treated with ferric carboxymaltose or iron isomaltoside

Detlie

Lindstrøm

Jahnsen

et al. 2019

Aliment Pharmacol Ther

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“…Post‐marketing data for FCM indicates that, in most cases, hypophosphatemia resolved within three months 58 . Nevertheless, a search of the PubMed database of literature published between January 1, 2008 and May 20, 2020 of randomized controlled trials, case studies, and observational studies, identified 12 post‐marketing reports of symptomatic hypophosphatemia leading to osteomalacia or rickets following FCM treatment for iron deficiency 65‐76 . A majority of these reports included the use of multiple FCM courses over a prolonged period of time.…”

Section: Hypophosphatemia: Presentation Diagnosis Causes and Treatmentioning

confidence: 99%

“…63,64 Transient hypophosphatemia findings based solely on laboratory without management of the underlying primary cause of the anemia; consequently, hypophosphatemia is a distinct possibility through the FGF23 activation pathway (Table 3). [65][66][67][68][69][70][71][72][73][74][75][76] On the other hand, CKD may be protective against hypophosphatemia, as there is reduced capacity for renal excretion of phosphate. Considering that patients with CKD are deemed to be at decreased risk of developing this adverse outcome, clinical trials investigating the incidence of hypophosphatemia occurring with intravenous iron formulations have excluded patients with an estimated GFR < 65 mL/min/1.73 m 2 .…”

Section: Iron Deficiency Increases Synthesis Of Fgf23 and Also Increa...mentioning

confidence: 99%

Parenteral iron therapy and phosphorus homeostasis: A review

et al. 2021

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Phosphorus has an essential role in cellular and extracellular metabolism; maintenance of normal phosphorus homeostasis is critical. Phosphorus homeostasis can be affected by diet and certain medications; some intravenous iron formulations can induce renal phosphate excretion and hypophosphatemia, likely through increasing serum concentrations of intact fibroblast growth factor 23. Case studies provide insights into two types of hypophosphatemia: acute symptomatic and chronic hypophosphatemia, while considering the role of pre‐existing conditions and comorbidities, medications, and intravenous iron. This review examines phosphorus homeostasis and hypophosphatemia, with emphasis on effects of iron deficiency and iron replacement using intravenous iron formulations.

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“…27 In addition, chronic clinical consequences such as osteomalacia-a softening or weakening of the bone that manifests as bone pain and fractures-have been described in patients receiving large cumulative doses of FCM. [28][29][30][31][32][33][34][35] The purpose of this study was to assess the incidence of moderate/severe hypophosphataemia and its potential clinical consequences after IV iron therapy with FCM among a broad cohort of hospitalised patients at the University College London Hospitals (UCLH) NHS Foundation Trust.…”

Section: Introductionmentioning

confidence: 99%

Hypophosphataemia after intravenous iron therapy with ferric carboxymaltose—Real world experience from a tertiary centre in the UK

et al. 2020

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Summary Background Iron deficiency is the most common global cause of anaemia. Intravenous (IV) iron is used to correct iron deficiency anaemia (IDA) where oral iron cannot be used. Despite being effective, certain IV iron formulations cause significant hypophosphataemia. However, current knowledge on the clinical consequences of IV iron‐induced hypophosphataemia is broadly anecdotal or limited to isolated case reports. Aims To retrospectively examine the incidence and potential clinical consequences of hypophosphataemia post‐IV ferric carboxymaltose (FCM) in hospitalised patients with IDA (mixed aetiology). Methods Data were collected for 162 patients, who received a total of 169 FCM courses during a 2‐year audit period. Outcomes included incidence of moderate/severe hypophosphataemia (serum phosphate <0.65 mmol/L) ≤90 days post‐FCM, changes in alkaline phosphatase, need for phosphate replacement, and length of hospital stay. Results The incidence of moderate/severe hypophosphataemia post‐FCM was 33.7%; within this group the rate of severe hypophosphataemia (serum phosphate ≤0.32 mmol/L) was 8.8%. Moderate/severe hypophosphataemia persisted, with 35% of patients having a serum phosphate of <0.65 mmol/L for ≤90 days at the last measurement after IV FCM. Intervention with IV phosphate—an average of 4.4 infusions per person—was required in 29.8% of cases with moderate/severe hypophosphataemia. FCM‐induced moderate/severe hypophosphataemia was associated with a significantly longer hospital stay (P < 0.0035). Conclusions Moderate/severe hypophosphataemia is a frequent adverse drug reaction with FCM. In our study, FCM‐induced moderate/severe hypophosphataemia was also persistent, often required treatment, and was associated with longer hospital stay.

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Symptomatic hypophosphataemic osteomalacia secondary to the treatment with iron carboxymaltose detected in bone scintigraphy

Cited by 10 publications

References 8 publications

Incidence of hypophosphatemia in patients with inflammatory bowel disease treated with ferric carboxymaltose or iron isomaltoside

Incidence of hypophosphatemia in patients with inflammatory bowel disease treated with ferric carboxymaltose or iron isomaltoside

Parenteral iron therapy and phosphorus homeostasis: A review

Hypophosphataemia after intravenous iron therapy with ferric carboxymaltose—Real world experience from a tertiary centre in the UK

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