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Tumor-induced Osteomalacia (TIO): Diagnosis and Management

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Jointly Provided by

CheckRare
Support for this activity has been made possible through an educational grant from Ultragenyx Pharmaceutical Inc.

Release date: 07/27/20
Expiration date: 09/30/21
Estimated time to complete: 0.25 hours

Activity Description

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic condition commonly characterized by bone pain, muscle weakness and fractures. These tumors secrete excess fibroblast growth factor 23 (FGF23) which inhibits the sodium phosphate renal co-transporters and suppresses 1α hydroxylase activity, thereby decreasing renal reabsorption and increased urinary phosphate excretion. As a result, unexplainable hypophosphatemia with a variety of musculoskeletal abnormalities are the most common symptoms. Unfortunately, the symptoms are relatively non-specific and phosphate levels are not routinely included in many comprehensive metabolic panels and/or hypophosphatemia is often overlooked. As a result, patients are often misdiagnosed with a variety of skeletal, rheumatologic, or neuro/neuro-psychiatric conditions.

Since the hallmarks of the disease are both pain that fails to respond to standard treatment plus hypophosphatemia, educating clinicians about the pathophysiology of TIO and its signs and symptoms can dramatically reduce the time to diagnose and establish a treatment program that can dramatically improve the patient’s quality of life.

To that end, this CME program is designed to educate clinicians who are likely to see these patients about the pathophysiology and early signs/symptoms of TIO so they are better prepared to recognize this rare but very treatable condition.

Activity Faculty

Peter Tebben, MD
Consultant, Division of Pediatric Endocrinology and Metabolism
Department of Pediatric and Adolescent Medicine
Assistant Professor of Medicine
Mayo Clinic
Rochester, MN

Target Audience

The target audience for this course is neurologists, rheumatologists, general practitioners, orthopedic specialists, and oncologists, and other related specialties involved in the diagnosis and management of tumor-induced osteomalacia (TIO). Nurses and other members of the care team may also participate.

Learning Objectives

After participating in the activity, learners should be better able to:

  • Identify the obstacles to suspecting and diagnosing TIO

Accreditation and Credit Designation

In support of improving patient care, this activity has been planned and implemented by American Academy of CME, Inc. and CheckRare CE. American Academy of CME, Inc. is Jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physicians
American Academy of CME, Inc., designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Other members of the care team will receive a certificate of participation.

Disclosure Statement

According to the disclosure policy of the Academy, all faculty, planning committee members, editors, managers and other individuals who are in a position to control content are required to disclose any relevant relationships with any commercial interests related to this activity. The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation. All educational materials are reviewed for fair balance, scientific objectivity and levels of evidence.

Disclosures are as follows:

Dr. Tebben has the following relationships to disclose:

  • Grant Recipient/Research Support: Ultragenyx (No longer study member)

Planners for this activity have no relevant financial relationships with any commercial interests.

This activity will review off-label or investigational information.

The opinions expressed in this educational activity are those of the faculty, and do not represent those of the Academy or CheckRare CE. This activity is intended as a supplement to existing knowledge, published information, and practice guidelines. Learners should appraise the information presented critically, and draw conclusions only after careful consideration of all available scientific information.

Method of Participation

There are no fees to participate in the activity. Participants must review the activity information including the learning objectives and disclosure statements, as well as the content of the activity. To receive CME credit for your participation, please complete the post-program assessment. Your certificate can be mailed to you in approximately 30 days.

Hardware/Software Requirements

Windows Requirements: • Operating system: Windows XP Service Pack 2 or later • Browser: Internet Explorer 7 or later, Mozilla Firefox 2.5 or later • Internet connection: DSL, cable modem, or other high-speed connection

Macintosh Requirements: • Operating system: Mac OS X v10.3 or later • Browser: Mozilla Firefox 2.5 or later • Internet connection: DSL, cable modem, or other high-speed connection

Privacy

For more information about the American Academy of CME privacy policy, please access http://www.academycme.org/privacy.htm. For more information about CheckRare’s privacy policy, please access https://checkrare.com/privacy/

Contact

For any questions, please contact: CEServices@academycme.org

Copyright

© 2020. This CME-certified activity is held as copyrighted © by American Academy of CME and CheckRare CE. Through this notice, the Academy and CheckRare grant permission of its use for educational purposes only. These materials may not be used, in whole or in part, for any commercial purposes without prior permission in writing from the copyright owner(s).

Tumor-induced Osteomalacia (TIO): Diagnosis and Management

Tumor-induced Osteomalacia (TIO): Diagnosis and Management0

Jointly Provided by

CheckRare
Support for this activity has been made possible through an educational grant from Ultragenyx Pharmaceutical Inc.

Release date: 07/27/20
Expiration date: 09/30/21
Estimated time to complete: 0.25 hours

Activity Description

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic condition commonly characterized by bone pain, muscle weakness and fractures. These tumors secrete excess fibroblast growth factor 23 (FGF23) which inhibits the sodium phosphate renal co-transporters and suppresses 1α hydroxylase activity, thereby decreasing renal reabsorption and increased urinary phosphate excretion. As a result, unexplainable hypophosphatemia with a variety of musculoskeletal abnormalities are the most common symptoms. Unfortunately, the symptoms are relatively non-specific and phosphate levels are not routinely included in many comprehensive metabolic panels and/or hypophosphatemia is often overlooked. As a result, patients are often misdiagnosed with a variety of skeletal, rheumatologic, or neuro/neuro-psychiatric conditions.

Since the hallmarks of the disease are both pain that fails to respond to standard treatment plus hypophosphatemia, educating clinicians about the pathophysiology of TIO and its signs and symptoms can dramatically reduce the time to diagnose and establish a treatment program that can dramatically improve the patient’s quality of life.

To that end, this CME program is designed to educate clinicians who are likely to see these patients about the pathophysiology and early signs/symptoms of TIO so they are better prepared to recognize this rare but very treatable condition.

Activity Faculty

Peter Tebben, MD
Consultant, Division of Pediatric Endocrinology and Metabolism
Department of Pediatric and Adolescent Medicine
Assistant Professor of Medicine
Mayo Clinic
Rochester, MN

Target Audience

The target audience for this course is neurologists, rheumatologists, general practitioners, orthopedic specialists, and oncologists, and other related specialties involved in the diagnosis and management of tumor-induced osteomalacia (TIO). Nurses and other members of the care team may also participate.

Learning Objectives

After participating in the activity, learners should be better able to:

  • Identify the obstacles to suspecting and diagnosing TIO

Accreditation and Credit Designation

In support of improving patient care, this activity has been planned and implemented by American Academy of CME, Inc. and CheckRare CE. American Academy of CME, Inc. is Jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physicians
American Academy of CME, Inc., designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Other members of the care team will receive a certificate of participation.

Disclosure Statement

According to the disclosure policy of the Academy, all faculty, planning committee members, editors, managers and other individuals who are in a position to control content are required to disclose any relevant relationships with any commercial interests related to this activity. The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation. All educational materials are reviewed for fair balance, scientific objectivity and levels of evidence.

Disclosures are as follows:

Dr. Tebben has the following relationships to disclose:

  • Grant Recipient/Research Support: Ultragenyx (No longer study member)

Planners for this activity have no relevant financial relationships with any commercial interests.

This activity will review off-label or investigational information.

The opinions expressed in this educational activity are those of the faculty, and do not represent those of the Academy or CheckRare CE. This activity is intended as a supplement to existing knowledge, published information, and practice guidelines. Learners should appraise the information presented critically, and draw conclusions only after careful consideration of all available scientific information.

Method of Participation

There are no fees to participate in the activity. Participants must review the activity information including the learning objectives and disclosure statements, as well as the content of the activity. To receive CME credit for your participation, please complete the post-program assessment. Your certificate can be mailed to you in approximately 30 days.

Hardware/Software Requirements

Windows Requirements: • Operating system: Windows XP Service Pack 2 or later • Browser: Internet Explorer 7 or later, Mozilla Firefox 2.5 or later • Internet connection: DSL, cable modem, or other high-speed connection

Macintosh Requirements: • Operating system: Mac OS X v10.3 or later • Browser: Mozilla Firefox 2.5 or later • Internet connection: DSL, cable modem, or other high-speed connection

Privacy

For more information about the American Academy of CME privacy policy, please access http://www.academycme.org/privacy.htm. For more information about CheckRare's privacy policy, please access https://checkrare.com/privacy/

Contact

For any questions, please contact: CEServices@academycme.org

Copyright

© 2020. This CME-certified activity is held as copyrighted © by American Academy of CME and CheckRare CE. Through this notice, the Academy and CheckRare grant permission of its use for educational purposes only. These materials may not be used, in whole or in part, for any commercial purposes without prior permission in writing from the copyright owner(s).