(HOME) Subject: osteomalacia/iron

   Endocr J 1998 Aug;45(4):431-9
   
Saccharated ferric oxide-induced osteomalacia in Japan: iron-induced osteopathy
due to nephropathy.

    Sato K, Shiraki M
    
   Department of Medicine, Institute of Clinical Endocrinology, Tokyo
   Women's Medical College, Japan.
   
   [Medline record in process]
   
   Saccharaed ferric oxide (SFO)-induced osteomalacia develops when
   excessive SFO infusions are administrated to patients with anemia for
   prolonged periods for a few years. The small particles and almost
   neutral saccharide of SFO filter through the glomerular tufts into the
   renal tubules, resulting in impairment of proximal renal tubular
   function, particularly renal reabsorption of phosphate and
   1alpha-hydroxylase activity, resulting in decreased serum levels of
   phosphorus and active vitamin D, both of which lead to development of
   hypophosphatemic osteomalacia. Furthermore, SFO, at concentrations
   attainable in serum, exacerbates the osteomalacia by inhibiting bone
   formation directly. In contrast to itai-itai disease, another
   iatrogenic osteomalacia due to cadmium nephropathy [44], the proximal
   renal tubular function impairment induced by SFO is reversible simply
   by discontinuing the nephrotoxin, which is followed by improvement of
   all the clinical manifestations, except bone deformities. So far,
   SFO-induced osteomalacia, that is, SFO-induced osteopathy due to
   nephropathy, has been reported only in Japan, probably due to the lax
   surveillance system of the health insurance scheme. All physicians who
   prescribe SFO should be aware of its severe adverse effects. We hope
   that such iatrogenic osteomalacia caused by abusive infusion of SFO
   will never again be reported in our country.
   
   PMID: 9881891, UI: 99096218
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