Tumor-induced osteomalacia—a diagnostic dilemma for an orthopedic surgeon

Tumor-induced osteomalacia is a rare condition caused by excess production of phosphatonins most notably fibroblast growth factor−23 (FGF-23), by the tumor cells, leading to phosphate wasting and consecutive severe hypophosphatemia. This results in patient developing gradually progressive muscle weakness and bone loss resulting in severe osteomalacia, making the patient bedbound. These tumors are mostly benign mesenchymal tumors, which remain hidden in soft tissues or bone and thus are difficult to diagnose. And in the presence of normal serum calcium and parathyroid levels with only mild alteration of vitamin D levels, the diagnosis gets further delayed causing a lot of apathy to the patient. We hereby present a thorough review of this condition along with our experience in diagnosing and treating this patient. This underlines the fact that a high index of suspicion is required for diagnosing this condition in a patient with persistent complains of fatigue and bone pains. Appropriate investigations done at an early stage can help one in identifying and excising these tumors, bringing about a rapid relief of symptoms and saving the patient from a lot of distress.