Vitamin D and bone.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Disclosure Conflicts of interest: D.D. Bikle: has received grant support from the National Institutes of Health (RO1 DK054793, AR055924, and AR050023); and receives loyalties from Lange textbook chapter. 13. Am J Surg Pathol. 1989 Jul;13(7):588-99. doi: 10.1097/00000478-198907000-00007. Tumor-induced osteomalacia and rickets. Nuovo MA(1), Dorfman HD, Sun CC, Chalew SA. Author information: (1)Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 100467-2490. Tumor-induced osteomalacia is a clinicopathological entity in which vitamin D-resistant osteomalacia or rickets occurs in association with a tumor. A total of 72 cases (three current, 69 from review of literature) has been reported to date. Men and women are equally affected. The majority are adults over 30 years old who exhibit progressive lower leg and back pain. Forty bone and 31 soft-tissue tumors were responsible for this syndrome; two-thirds occurred in the extremities. Chemical findings are typical: low serum phosphorus, normal serum calcium, and elevated alkaline phosphatase. Serum levels of 1,25-dihydroxyvitamin D were low or undetectable. Histologically, more than a third were classified as vascular tumors, and half of these cases were hemangiopericytomas that were distributed equally between bone and soft tissues. Other common diagnoses included nonossifying fibromas, "mesenchymal" and giant-cell tumor variants. Features common to all tumors were prominent vascularity, and giant and primitive stromal cells. Only 10 were histologically malignant. Ultrastructural studies have not shown any secretory granules suggestive of a hormone-secreting tumor. It is clear, however, that the tumor is responsible for the osteomalacia because the complete removal generally results in a dramatic reversal of all symptoms and signs. DOI: 10.1097/00000478-198907000-00007