We present a case of a 53-year-old woman who developed
multifocal insufficiency fractures associated with adefovir
dipivoxil (ADV) induced osteomalacia, including recurring
metatarsal insufficiency fractures and a subtrochanteric
femoral insufficiency fracture requiring surgical fixation.
She had received low-dose ADV treatment for 59 months for
chronic hepatitis B viral infection at the time of presentation
with subtrochanteric fracture. Imaging evidence of
multifocal insufficiency fractures and metabolic disease on
background of hypophosphatemia is attributed to
hypophosphatemic osteomalacia from adefovir-induced
renal proximal tubular dysfunction. Radiologists and
clinicians should be aware of the possibility of insufficiency
fractures in patients receiving ADV therapy to avoid delayed
diagnosis and progression of high-risk proximal femoral
fractures.
Osteomalacia