Bone pain with scintigraphy suggestive of widespread metastases—do not forget phosphate

(Section Editor: K. Kühn) Two adult patients underwent skeletal scintigraphy due to debilitating bone pain, which was highly suggestive of diffuse osseous metastases. Disturbances of phosphate metabolism were considered for the first time after a 1‐year latency period. Marked hypophosphataemia and hyperphosphaturia were found in both patients and subsequently a bone biopsy showed a typical histologic pattern of osteomalacia. The present case reports demonstrate the broad spectrum of diseases leading to acquired renal phosphate wasting in adults and underline the importance of considering the cheap and simple blood testing for inorganic phosphate during the diagnostic work‐up of bone pain. Patient A (63 years) and patient B (73 years), both Caucasian males, suffered from diffuse, progressive bone pain and tenderness to palpation for more than 12 months before admission. Technetium‐99m DPD‐labelled scintigraphic examination showed generalized increased bone uptake and numerous focal areas of increased radionuclide accumulation bilaterally, especially in the ribs. Multiple skeletal metastases was the primary diagnosis in both patients. Both were subsequently admitted to our hospital because the search for an underlying malignant tumour had been unsuccessful. Upon admission, both patients had proximal muscle weakness of the lower extremities. Arterial hypertension was the only relevant concomitant disease. The personal and family histories were otherwise unremarkable in both patients. Radiological examination revealed pseudofractures and several bone fractures of different ages without a history of adequate trauma. Skeletal scintigraphy confirmed the previous findings (Figures 1 and 2). Laboratory tests are listed in Table 1.