Tumor induced osteomalacia also known as oncogenic osteomalacia is a rare paraneoplastic syndrome of abnormal phosphate and vitamin metabolism caused by typically small endocrine tumors that secrete the phosphaturic hormone, fibroblast, GF-23. We present a case report of bilateral intertrochanteric fracture treated with DHS which was secondary to tumor induced osteomalacia.

Methods: 36 yrs old male, complained of difficulty in walking, weakness in both lower limbs and developed sudden onset of severe LBA radiating to buttocks and legs. Patient presented with h/o pain after he fell down from stairs and was managed conservatively elsewhere and presented to KLEH for the same complaints after 1 month. Routine investigation was done and the CT scan s/o lesion in the femur head. DOTA SCAN s/o DOTA and sclerotic lesion in the right femur head. He was started on Joule's scan. B/L DHS application and biopsy was done followed by RFA. PostOp phosphorus levels were 2.1 mg%. Repeat DOTA SCAN showed no uptake.

Result: Patient had normal RFT, biochemical evaluation showed persistent hypophosphatemia, raised ALP levels and was started on Joule's solution. Post-surgery along with RFA, repeat DOTA SCAN showed no uptake and after removal of DHS, patient had no difficulty in walking and patient's weakness and pain improved.

Conclusion: Oncogenic osteomalacia is uncommon yet curable cause of osteomalacia. The key to cure the individual cases remains reserved to the physician and his intelligence. Definitive treatment is the surgical removal of tumor with dramatic and satisfying results.

Keywords: Tumor induced osteomalacia; Paraneoplastic syndromes; Osteoporosis; Oncogenic osteomalacia.