Adult-onset hypophosphatemic osteomalacia as a cause of widespread musculoskeletal pain: A retrospective case series of single center experience

Figure 1 Bone scintigraphic and radiologic findings of adult-onset hypophosphatemic osteomalacia. A: Bone scintigraphy of patient #5 shows multiple foci of increased radiotracer uptake in multiple costovertebral/costotransverse joints, bilateral costochondral junctions (blue thin arrows: Costochondral beading or “adult rachitic rosary” appearance), arc of the ribs, cervicothoracolumbar vertebral bodies, sacrum, right humerus, left calcaneus, and right midtarsal bone; B: Bone scintigraphy of patient #8 shows multiple foci of increased radiotracer uptake in the thoracolumbar vertebral bodies, costovertebral junctions, costochondral junctions, posterior arc of the ribs, bilateral scapula, sacrum, pelvic bone, bilateral distal femur and proximal tibia (blue arrows and arrowheads: Pseudo-reactivation of the growth plate), bilateral calcaneus, right distal tibia, and right midtarsal bone; C: Axial computed tomography (CT) image of patient #2 shows insufficiency fracture of the neck and tubercle of the ribs (thick orange arrows); D and E: Coronal and sagittal CT images of patient #8 reveals insufficiency fracture of bilateral distal femur (thick orange arrows in D, proximal tibia (orange arrowheads in D), and left calcaneus (thick orange arrow in E); F: CT of patient #1 shows transverse linear radiolucency on the lateral aspects of the subtrochanteric area of both femurs (Looser’s zone or pseudo-fracture) (thick orange arrows); G: Magnetic resonance imaging of the shoulder of patient #4 shows overt fracture of the right scapula (thick orange arrow); H: Axial image of ⁶⁸Ga-DOTATOC positron emission tomography/CT of patient #1 shows small, focal increased radiotracer uptake on the inner surface of the right temporal bone (thick orange arrow).