{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:40:27Z","timestamp":1787240427633,"version":"build-2736575974"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T00:00:00Z","timestamp":1607472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["asbmr.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JBMR Plus"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Excess fibroblast growth factor 23 (FGF23), excess PTH, and an increase in extracellular calcium cause hypophosphatemia by lowering the maximum renal phosphate reabsorption threshold (TmP\/GFR). We recently reported two cases of X\u2010linked hypophosphatemia (XLH) with severe tertiary hyperparathyroidism who had normalization of TmP\/GFR upon being rendered hypoparathyroid following total parathyroidectomy, despite marked excess in both C\u2010terminal FGF23 (cFGF23) and intact FGF23 (iFGF23). We explored the effects of FGF23, PTH, and calcium on TmP\/GFR in a cross\u2010sectional study (\n                    <jats:italic>n<\/jats:italic>\n                    =\u200974) across a spectrum of clinical cases with abnormalities in TmP\/GFR, PTH, and FGF23. This comprised three groups: FGF23\u2010dependent hypophosphatemia (\n                    <jats:italic>n<\/jats:italic>\n                    =\u200927), hypoparathyroidism (HOPT;\n                    <jats:italic>n<\/jats:italic>\n                    =\u200917), and chronic kidney disease (\n                    <jats:italic>n<\/jats:italic>\n                    =\u200930). Measurements included TmP\/GFR, cFGF23, PTH, ionized calcium, vitamin D metabolites, and bone turnover markers. The combined effect of cFGF23, PTH, and ionized calcium on TmP\/GFR was modeled using hierarchical multiple regression and was probed by moderation analysis with PROCESS. Modeling analysis showed independent effects on TmP\/GFR by cFGF23, PTH, and ionized calcium in conjunction with a weak but significant effect of the interaction term for PTH and FGF23; probing showed that the effect was most prominent during PTH deficiency. Teriparatide 20\u2009\u03bcg daily was self\u2010administered for 28\u2009days by one case of X\u2010linked hypophosphatemia with hypoparathyroidism (XLH\u2010HOPT) to assess the response of TmP\/GFR, cFGF23, iFGF23, nephrogenous cyclic adenosine monophosphate (NcAMP), vitamin D metabolites, and bone turnover markers. After 28\u2009days, TmP\/GFR was lowered from 1.10\u2009mmol\/L to 0.48\u2009mmol\/L; this was accompanied by increases in NcAMP, ionized calcium, and bone turnover markers. In conclusion, the effect of FGF23 excess on TmP\/GFR is altered by PTH such that the effect is ameliorated by hypoparathyroidism and the effect is augmented by hyperparathyroidism. \u00a9 2020 The Authors.\n                    <jats:italic>JBMR Plus<\/jats:italic>\n                    published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.\n                  <\/jats:p>","DOI":"10.1002\/jbm4.10437","type":"journal-article","created":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T22:59:09Z","timestamp":1606258749000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Renal Phosphate Handling: Independent Effects of Circulating\n                    <scp>FGF23<\/scp>\n                    ,\n                    <scp>PTH<\/scp>\n                    , and Calcium"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6564-7011","authenticated-orcid":false,"given":"Malachi J","family":"McKenna","sequence":"first","affiliation":[{"name":"UCD School of Medicine University College Dublin  Dublin Ireland"},{"name":"Department of Clinical Chemistry St. Vincent's University Hospital  Dublin Ireland"},{"name":"Department of Endocrinology St. Vincent's University Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel K","family":"Crowley","sequence":"additional","affiliation":[{"name":"UCD School of Medicine University College Dublin  Dublin Ireland"},{"name":"Department of Clinical Chemistry St. Vincent's University Hospital  Dublin Ireland"},{"name":"Department of Endocrinology St. Vincent's University Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J","family":"Twomey","sequence":"additional","affiliation":[{"name":"UCD School of Medicine University College Dublin  Dublin Ireland"},{"name":"Department of Clinical Chemistry St. Vincent's University Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark T","family":"Kilbane","sequence":"additional","affiliation":[{"name":"UCD School of Medicine University College Dublin  Dublin Ireland"},{"name":"Department of Clinical Chemistry St. Vincent's University Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,12,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1359\/JBMR.0301264"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.90742.2008"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-018-4618-2"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.3843"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-1319"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198012113032401"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0009-8981(69)90280-0"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI112253"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-0724"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.070304"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2017"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-2705"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1947-8-84"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00774-018-0957-5"},{"issue":"3","key":"e_1_2_9_16_1","first-page":"529","article-title":"Rickets resistant to vitamin D therapy","volume":"54","author":"Albright F","year":"1937","journal-title":"Am J Dis Child"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196910022811404"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-60-4-711"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.3992"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-68-3-553"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.175.4025.997"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(75)92736-1"},{"issue":"1","key":"e_1_2_9_23_1","first-page":"23","article-title":"Relation of plasma phosphate concentration to renal tubular reabsorption of phosphate","volume":"37","author":"Bijvoet OL","year":"1969","journal-title":"Clin Sci."},{"key":"e_1_2_9_24_1","volume-title":"Defining, establishing and verifying reference intervals in the clinical laboratory; 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