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Case Reports
. 2014 Feb;21(1):76-83.
doi: 10.11005/jbm.2014.21.1.76. Epub 2014 Feb 28.

Two Cases of Hypophosphatemic Osteomalacia After Long-term Low Dose Adefovir Therapy in Chronic Hepatitis B and Literature Review

Hye Jin Jeong  1 , Ji Min Lee  1 , Tae Han Lee  1 , Ji Yeon Lee  1 , Han Byeol Kim  1 , Mi Hwa Heo  1 , Go Choi  1 , Jin Nyeong Chae  1 , Ji-Min Kim  1 , Sang-Hyon Kim  1 , Kun Young Kwon  2
Affiliations
Case Reports

Two Cases of Hypophosphatemic Osteomalacia After Long-term Low Dose Adefovir Therapy in Chronic Hepatitis B and Literature Review

Hye Jin Jeong et al. J Bone Metab. 2014 Feb.

Abstract

Adefovir dipivoxil (ADV) is a nucleotide used as long-term therapy of chronic hepatitis B. Many published reports have shown that long-term high-dose therapy with adefovir can be associated with proximal renal tubular dysfunction resulting in significant hypophosphatemia, renal insufficiency and osteomalacia. We have encountered two patients who developed evidence of hypophosphatemic osteomalacia while on long-term low-dose adefovir therapy for chronic hepatitis B. We report on its clinical features and its potential resolution with cessation of the drug and supplementation with phosphate. We also reviewed the other published cases associated with hypophosphatemic osteomalacia after low-dose adefovir therapy. The symptoms and the hypophosphatemia improved after cessation of the drug and supplementation with phosphate in most cases. Patients taking adefovir long-term should receive regular investigation of the phosphate level and renal function.

Keywords: Adefovir dipivoxil; Hypophosphatemia; Kidney diseases; Osteomalacia.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Simple x-ray of pelvis showed osteopenia. Suspicous cortical disruption at left superior pubic ramus. R/O fracture (arrow).
Fig. 2
Fig. 2
Bone mineral densitys of 2 cases show markedly reduced bone density of spine.
Fig. 3
Fig. 3
(A) Whole body bone scan reveals multiplehot spots at anterior and posterior aspect of right 1-10th ribs, and left 1-11th ribs, spinous process of C-7, left 5-9th costovertebral junctions, posterior aspect of left ischium and right sided sacral wing (case 1). (B) Whole body bone scan reveals multiple hot spots in both bony ribs (case 2).
Fig. 4
Fig. 4
Fracture of C7 spinous process.
Fig. 5
Fig. 5
(A) Light microscopic findings show unmineralized irregular bony spicules and abundant fibrotic marrow spaces. (B) High magnification of a shows unmineralized osteoid tissue with many osteoblastic cells (arrows). Hematoxylin-Eosin stain, A: ×40, B: ×200.
See this image and copyright information in PMC

References

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    1. Lee HC, Song YD, Ahn KJ, et al. A case adult onset hypophosphatemic osteomalacia. J Korean Soc Endocrinol. 1991;6:75–81.
    1. Yoo KD, Jeong JH, Cho SK, et al. A case of hypophosphatemic osteomalacia associated with low-dose adefovir dipivoxil treatment. Korean J Med. 2010;78:261–265.
    1. Lee KS, Kim DJ. Management of chronic hepatitis B. Korean J Hepatol. 2007;13:447–488. - PubMed
    1. Tanji N, Tanji K, Kambham N, et al. Adefovir nephrotoxicity: possible role of mitochondrial DNA depletion. Hum Pathol. 2001;32:734–740. - PubMed

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