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This version was published on 1 March 2009
Ann Clin Biochem 2009;46:167-169
doi:10.1258/acb.2008.008151
© 2009 Association for Clinical Biochemistry

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Case Reports

Iron polymaltose-induced FGF23 elevation complicated by hypophosphataemic osteomalacia

Belinda J Schouten, Matthew P Doogue, Steven G Soule and Penelope J Hunt


Department of Endocrinology, Christchurch Public Hospital, Christchurch, New Zealand


Corresponding author: Belinda Schouten. Email: Belinda.Robb{at}cdhb.govt.nz

Iron-induced renal phosphate wasting, hypophosphataemia and osteomalacia have previously been reported in a small number of Japanese patients receiving parenteral iron sucrose. We report the case history of a European male who, as a result of regular intravenous iron polymaltose, developed prolonged hypophosphataemia complicated by widespread insufficiency fractures. The pathogenesis of this complication remains unknown however our novel finding of a marked elevation in fibroblast growth factor 23 (FGF23), which normalized after ceasing parenteral iron, suggests an important and previously unreported effect of iron on FGF23 homeostasis.


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B. J. Schouten, P. J. Hunt, J. H. Livesey, C. M. Frampton, and S. G. Soule
FGF23 Elevation and Hypophosphatemia after Intravenous Iron Polymaltose: A Prospective Study
J. Clin. Endocrinol. Metab., July 1, 2009; 94(7): 2332 - 2337.
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