Shift in Calcium from Peripheral Bone to Axial Bone after Tumor Resection in Patients with Tumor-Induced Osteomalcia.

Shift in Calcium from Peripheral Bone to Axial Bone after Tumor Resection in Patients with Tumor-Induced Osteomalcia.
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肿瘤引起的骨软化症患者肿瘤切除后钙从周围骨转移到轴向骨。

DOI：
10.1210/clinem/dgad252
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发表时间：
2023
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
通讯作者：
W. Xia
W. Xia
中科院分区：
--
文献类型：
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作者：
X. Ni;Zaizhu Zhang;W. Guan;Y. Chi;Xiang Li;Yiyi Gong;Q. Pang;Wei Yu;Huanwen Wu;L. Huo;Yong Liu;Jin Jin;Xiaoping Zhou;W. Lv;Lian Zhou;Yu;Wei Liu;R. Jiajue;L. Cui;O. Wang;Mei Li;X. Xing;Yan Jiang;W. Xia

文献摘要

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上下文 肿瘤诱导的骨软化症（TIO）是一种罕见的副肿瘤综合征，由肿瘤过度产生成纤维细胞生长因子23（FGF 23）引起。肿瘤切除成功后，患者可迅速从低磷血症中恢复。然而，术后短期内骨矿物质密度（BMD）和微观结构变化的数据仍不清楚。 目标 探讨TIO患者术后周围骨和中轴骨的骨密度和显微结构的变化。 设计、设置、受试者和主要结局指标 在这项回顾性研究中，我们在术前和术后3个月使用高分辨率外周定量计算机断层扫描（HR-pQCT）和双能X线吸收测定法（DXA）评估了22例TIO患者的BMD和微结构。 结果 在本研究中，共入组了22例术后血清磷酸盐水平恢复的TIO患者。术后，股骨颈的面骨密度（aBMD）增加了21.6%，全髋增加了18.9%，腰椎增加了29.5%。此外，TBS增加了14.1%（均p < 0.001）。相反，骨小梁或皮质体积BMD（vBMD），骨小梁（骨小梁数量，分离和骨体积比）和皮质骨（皮质厚度和孔隙度）在桡骨远端或胫骨的微观结构进一步恶化。相关分析发现，股骨颈和全髋aBMD的变化与骨小梁vBMD和骨体积比的变化相反，而与桡骨远端骨小梁分离的变化呈正相关。 结论 尽管中轴骨的aBMD和微观结构得到改善，但术后不久外周骨的vBMD和微观结构进一步受损。全髋关节和股骨颈aBMD改善与vBMD恶化和桡骨远端显微结构的相关性表明，TIO患者肿瘤切除术后短期内钙从外周骨向中轴骨转移。
CONTEXT Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by excessive production of fibroblast growth factor 23 (FGF23) by a tumor. After successful tumor resection, patients could recover from hypophosphatemia quicky. However, data on the changes in bone mineral density (BMD) and microstructure in the short term after surgery remained unclear. OBJECTIVES To investigate the postoperative changes in BMD and microstructure in both peripheral and axial bone in TIO patients. DESIGN, SETTING, PARTICIPANTS AND MAIN OUTCOME MEASUREMENTS We evaluated BMD and microarchitecture in 22 TIO patients using high-resolution peripheral quantitative computed tomography (HR-pQCT) and dual-energy X-ray absorptiometry (DXA) before and 3 months after surgery in this retrospective study. RESULTS In this study, a total of 22 TIO patients who had recovered serum phosphate levels postoperatively were enrolled. After surgery, areal BMD (aBMD) increased by 21.6% in the femoral neck, by 18.9% in the total hip, and by 29.5% in the lumbar spine. Moreover, TBS increased by 14.1% (all p < 0.001). In contrast, trabecular or cortical volumetric BMD (vBMD), and microstructure of trabecular bone (trabecular number, separation and bone volume ratio) and cortical bone (cortical thickness and porosity) at the distal radius or tibia were further deteriorated. Correlation analyses found that both changes in femoral neck and total hip aBMD were conversely associated with changes in trabecular vBMD and bone volume ratio, while positively correlated with change in trabecular separation at the distal radius. CONCLUSIONS Although aBMD and microstructure in the axial bone were improved, vBMD and microstructure in the peripheral bone were further impaired shortly after surgery. Correlation of improvement of aBMD in the total hip and femoral neck with deterioration of vBMD and microstructure at the distal radius indicated shift in calcium from the peripheral bone to the axial bone in the short term after tumor resection in TIO patients.