Late diagnosis of SLC34A3-related hereditary hypophosphatemic osteomalacia following a low-energy proximal humeral 4-part fracture.

-related phosphate-wasting disorders may remain clinically unrecognized until late adulthood. Importantly, it highlights the value of biochemical evaluation, including the measurement of serum phosphate and the assessment of renal phosphate handling, in patients with otherwise unexplained skeletal fragility. Phosphate-wasting disorders should be considered in patients with recurrent fractures or skeletal fragility that is not fully explained by BMD or the reported injury mechanism.