Clinical characteristics of pediatric tumor-induced osteomalacia: a systematic review and individual patient data analysis.

Rong Chen, Zhangxin Wen, Cheng Cheng, Xinping Li, Jingyi Wang, Hong Liu, Hailing Chen

Journal: Frontiers in endocrinology 2026;17():1871968

PMID: 42553050

Abstract

PURPOSE

Pediatric tumor-induced osteomalacia (TIO), also called Tumor-induced rickets (TIR), is characterized by renal phosphate wasting, resulting in hypophosphatemia and rickets. This study aimed to evaluate the clinical characteristics of pediatric TIO patients.

METHODS

A systematic search was performed on December 26, 2025, in PubMed, Elsevier, SpringerLink, the China National Knowledge Infrastructure, and Wanfang Data using the terms: "tumor-induced rickets," "tumor-induced hypophosphatemic rickets," "oncogenic osteomalacia," "hypophosphatemia," "tumor-induced osteomalacia," "children," "child," and "pediatrics". Studies published in English and Chinese were included. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.

RESULTS

A total of 62 pediatric TIO cases were included. Pediatric TIO was more frequent in males, who exhibited a higher proportion of weakness and deformities compared with females. 16.1% of patients were misdiagnosed with another condition. Somatostatin receptor-based imaging modalities demonstrated a high proportion for identifying these tumors. Pediatric TIO-causing neoplasms were predominantly located in the lower extremities and primarily originated from the bone tissue. Benign tumors were more common than malignant ones. The latter were associated with lower serum calcium levels. Surgery is the preferred definitive treatment for pediatric TIO, with an 84.2% resolution proportion.

CONCLUSION

Pediatric TIO affects males more frequently than females, with male patients exhibiting a higher proportion of weakness and deformities, and is prone to misdiagnosis. Neoplasms are mostly located in the lower extremities and are predominantly benign. Surgery is the preferred treatment for pediatric TIO. For hypophosphatemic pediatric patients, TIO should be considered to preventing adverse outcomes.

Address: Department of Osteoporosis, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.; Department of Metabolic Endocrinology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China.; Department of Osteoporosis, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.

DOI: 10.3389/fendo.2026.1871968

MeSH Terms: Humans, Child, Neoplasms, Connective Tissue, Male, Female, Paraneoplastic Syndromes, Osteomalacia, Hypophosphatemia, Neoplasms, Connective and Soft Tissue, Child, Preschool