Phosphate wasting disorders in adults

Osteoporos Int. 2018 Nov;29(11):2369-2387. doi: 10.1007/s00198-018-4618-2. Epub 2018 Jul 16.


A cause of hypophosphatemia is phosphate wasting disorders. Knowledge concerning mechanisms involved in phosphate wasting disorders has greatly increased in the last decade by the identification of phosphatonins, among them FGF-23. FGF-23 is a primarily bone derived factor decreasing renal tubular reabsorption of phosphate and the synthesis of calcitriol. Currently, pharmacological treatment of these disorders offers limited efficacy and is potentially associated to gastrointestinal, renal, and parathyroid complications; therefore, efforts have been directed toward newer pharmacological strategies that target the FGF-23 pathway. This review focuses on phosphate metabolism, its main regulators, and phosphate wasting disorders in adults, highlighting the main issues related to diagnosis and current and new potential treatments.

Keywords: FGF-23; Hypophosphatemia; Osteomalacia; Phosphate wasting disorders; Rickets; Treatment.

Publication types

  • Review

MeSH terms

  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors / physiology
  • Homeostasis / physiology
  • Humans
  • Hypophosphatemia / diagnosis
  • Hypophosphatemia / drug therapy
  • Hypophosphatemia / etiology*
  • Hypophosphatemia / metabolism*
  • Intestinal Absorption / physiology
  • Kidney / metabolism
  • Molecular Targeted Therapy / methods
  • Osteomalacia / diagnosis
  • Osteomalacia / drug therapy
  • Osteomalacia / etiology
  • Osteomalacia / metabolism
  • Phosphates / metabolism*


  • FGF23 protein, human
  • Phosphates
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23