Background: Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by phosphate wasting, leading to hypophosphatemia, bone pain, and fractures. Its nonspecific symptoms often delay diagnosis, complicating management.

Case Presentation: We report a rare case of a middle-aged patient presenting with bilateral intertrochanteric femur fractures without significant trauma. Biochemical evaluation revealed hypophosphatemia, elevated alkaline phosphatase, and low vitamin D levels. Further investigations identified a phosphaturic mesenchymal tumor responsible for TIO. Surgical excision of the tumor resulted in normalization of phosphate levels and clinical improvement.

Conclusion: This case highlights the importance of considering TIO in patients with unexplained fractures and metabolic bone disease. Early diagnosis and tumor localization are critical for effective treatment and prevention of further skeletal complications.