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Antacid and sucralfate-induced hypophosphatemic osteomalacia: A case report and review of the literature
Abstract
A 42-year-old woman presented to our institution with a 2-week history of bone pain in the lower extremities. Her history was remarkable for duodenal ulcer and long-term treatment with a magnesium-aluminum hydroxide antacid (Maalox) and sucralfate. Initial laboratory studies showed severe hypophosphatemia and elevated alkaline phosphatase and serum 1,25-dihydroxyvitamin D levels. Bone scan showed multiple areas of increased uptake consistent with osteomalacia and microfractures. The patient recovered completely following withdrawal of antacids and sucralfate and short-term treatment with phosphate. Although hypophosphatemia induced by aluminum-containing antacids is rare, treatment of peptic ulcer disease with a combination of two aluminum-containing agents may increase the risk of clinically significant hypophosphatemia. Awareness of this condition is important, because early recognition can prevent morbidity and lead to safe and effective treatment.
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There are case reports of osteomalacia and rickets in infants and adults using Al-containing antacids for the treatment of gastrointestinal illnesses.
“There are case reports of osteomalacia and rickets in infants and adults using Al-containing antacids for the treatment of gastrointestinal illnesses (Chines and Pacifici, 1990; Pivnick et al., 1995; Woodson, 1998).”
From Aluminium toxicosis: a review of toxic actions and effects (2019) · cites this paper as Chines and Pacifici, 1990
Citations
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“There are case reports of osteomalacia and rickets in infants and adults using Al-containing antacids for the treatment of gastrointestinal illnesses (Chines and Pacifici, 1990; Pivnick et al., 1995; Woodson, 1998).”
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Metadata
- Authors
- Chines, A., & Pacifici, R.
- Venue
- Calcified Tissue International
- Published
- 1990-11
- Volume
- 47
- Issue
- 5
- Pages
- 291-295
- ISSN
- 0171-967X (ISSN-L)
- 1432-0827
- OpenAlex
- W2043141625
- Cited by
- 44
- References
- 27
- Citations by year
- 2024: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 1 · 2016: 1 · 2014: 1 · 2013: 2 · 2012: 2
- FWCI
- 0.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Calcified Tissue International (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Vitamin D Research Studies
- Life Sciences › Agricultural and Biological Sciences › Plant Science › Aluminum toxicity and tolerance in plants and animals
- Keywords
- hypophosphatemic osteomalacia, sucralfate, magnesium aluminum hydroxide, hypophosphatemia, duodenal ulcer, peptic ulcer, phosphorus supplementation, 1,25-dihydroxyvitamin D, bone pain
- MeSH terms
- Adult, Aluminum Hydroxide, Antacids, Drug Combinations, Duodenal Ulcer, Female, Humans, Magnesium Hydroxide, Osteomalacia, Phosphates, Sucralfate
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