Osteomalacia in patients with Sjogren's syndrome. A review of three cases

Sjogren's syndrome is a multisystem disorder in which tubulointerstitial nephropathy is a feature in 20% of cases and osteomalacia secondary to tubular acidosis an occasional complication. Three cases are reported in patients who met European diagnostic criteria for Sjogren's syndrome. The diagnosis of osteomalacia was based on clinical, laboratory lest, and imaging study findings. Whether the pathophysiology of such cases involves a direct effect of H+ ions on hydroxyapatite crystals or disturbances in vitamin D metabolism is discussed based on these three cases and a literature review. Although rare, osteomalacia due to tubular acidosis should be considered routinely in Sjogren's syndrome patients with bone pain.