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Tumor-induced osteomalacia (TIO) can cause severe, persistent hypophosphatemia due to high fibroblast growth factor-23 (FGF-23) levels, which lead to urinary phosphate wasting. TIO is frequently encountered in association with mesenchymal tumors and responds well to resection of the primary malignancy. Rarely, TIO may be seen as a paraneoplastic phenomenon with solid organ malignancies where correction of biochemical abnormalities requires ongoing phosphorus replacement. We report a case of TIO in a patient with metastatic breast cancer