Fig. 2.

A 42-year-old man who had taken adefovir dipivoxil (ADV) (10 mg/day) for 7 years for treatment of chronic hepatitis B complained of a 2-year history of diffuse musculoskeletal pain in the anterior chest area with absence of antecedent trauma. Laboratory investigations showed a decreased serum phosphorus level (1.6 mg/dl, normal range, 2.5–4.5 mg/dl), increased serum ALP level (702 U/l, normal range, 104–338 U/l) with a slightly elevated serum creatinine level (1.6 mg/dl, normal range, 0.7–1.3 mg/dl). Multifocal hot spots were noted on both sides of the rib cage on whole-body bone scintigraphy with faint uptake in both kidneys. On the basis of these findings, the patient was diagnosed as having osteomalacia and pathological fractures associated with ADV therapy. Bone pain was significantly reduced after discontinuation of ADV and correction of the hypophosphatemia