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We used patient data retrospectively collected up to the time of informed consent in the SUNFLOWER study, a long-term observational study, to investigate the current treatment status and prevalence of comorbid hyperparathyroidism and its association with renal dysfunction in patients with XLH in Japan and South Korea. Of 69 patients who met the eligibility criteria, 32 (46.4%) did not have hyperparathyroidism (hereinafter referred to as non-hyperparathyroidism), 33 (47.8%) had secondary hyperparathyroidism, and four (5.8%) had tertiary hyperparathyroidism. Men were more prone to develop secondary and tertiary hyperparathyroidism, use oral phosphate at higher frequencies, and have a higher incidence of Stage\u2009\u2265\u20093 chronic kidney disease and Grade\u2009\u2265\u20093 renal calcification than women. Ongoing treatments for patients with XLH and non-hyperparathyroidism, secondary hyperparathyroidism, and tertiary hyperparathyroidism mainly consisted of active vitamin D (30 [93.8%], 25 [75.8%], and 3 [75.0%], respectively) and oral phosphate (21 [65.6%], 23 [69.7%], and 4 [100.0%], respectively). At informed consent, patients with tertiary hyperparathyroidism had the lowest estimated glomerular filtration rate values. Our study highlights the prevalence of comorbid hyperparathyroidism and its association with renal dysfunction in patients with XLH through a large-scale observational study in Asia.<\/jats:p>\n                  <jats:p>Trial registration: NCT03745521; UMIN000031605.<\/jats:p>","DOI":"10.1007\/s00223-025-01359-9","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T13:30:54Z","timestamp":1741786254000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prevalence of Comorbid Hyperparathyroidism and Its Association with Renal Dysfunction in Asian Patients with X-Linked Hypophosphatemic Rickets\/Osteomalacia"],"prefix":"10.1007","volume":"116","clinical-trial-number":[{"clinical-trial-number":"nct03745521","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"umin000031605","registry":"10.18810\/umin-japan"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4071-5372","authenticated-orcid":false,"given":"Nobuaki","family":"Ito","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Gyung","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshimi","family":"Michigami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriyuki","family":"Namba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuo","family":"Kubota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayumi","family":"Shintani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3880-762X","authenticated-orcid":false,"given":"Ryota","family":"Kawai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daijiro","family":"Kabata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruka","family":"Ishii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yayoi","family":"Nishida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiji","family":"Fukumoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Ozono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"issue":"7","key":"1359_CR1","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1002\/jbmr.340.Erratum.In:JBoneMinerRes2015;30:394","volume":"26","author":"TO Carpenter","year":"2011","unstructured":"Carpenter TO, Imel EA, Holm IA, Jan de Beur SM, Insogna KL (2011) A clinician\u2019s guide to X-linked hypophosphatemia. 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N.I. received support for the present manuscript (funding and medical writing support funding) from Kyowa Kirin to the author\u2019s institution; and grants and consulting fees from Kyowa Kirin. H.G.K. received grants or contracts from ChongKunDang, Handok, Kyowa Kirin, Amgen, Apellis Pharmaceuticals, and AstraZeneca; consulting fees from Handok and Kyowa Kirin; payment or honoraria for lectures, presentations, speakers\u2019 bureaus, manuscript writing or educational events from Alexion, Handok, and Kyowa Kirin; and participated on a Data Safety Monitoring Board or Advisory Board for Bayer. T.M. received support for the present manuscript (funding and medical writing support funding) from Kyowa Kirin to the author\u2019s institution; consulting fees from Kyowa Kirin and Alexion Pharmaceuticals; and payment or honoraria for lectures, presentations, speakers\u2019 bureaus, manuscript writing or educational events from Kyowa Kirin, Alexion Pharmaceuticals, Amgen, Chugai Pharmaceutical, Novo Nordisk, and BioMarin Pharmaceutical. N.N. received support for the present manuscript (funding and medical writing support funding) from Kyowa Kirin to the author\u2019s institution; consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Kyowa Kirin; and served a leadership or fiduciary role as Director for the Japanese Society for Pediatric Endocrinology (JSPE), Chair for the Bone and Mineral Metabolism Committee of the JSPE, and Chair for the Scientific Program Committee of the Asia Pacific Paediatric Endocrine Society (APPES). T.K. received support for the present manuscript (funding and medical writing support funding) from Kyowa Kirin to the author\u2019s institution; and consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Kyowa Kirin. A.S. received support for the present manuscript (funding and medical writing support funding) from Kyowa Kirin to the author\u2019s institution; consulting fees from Chugai Pharmaceutical (to the author\u2019s institution), Daiichi Sankyo (to the author\u2019s institution), Kyowa Kirin (to the author\u2019s institution), Takeda Pharmaceutical (to the author and author\u2019s institution), and Shionogi Pharma (to the author); and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, Asahi Kasei, AstraZeneca, Astellas Pharma, Bayer Yakuhin, Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Janssen Pharmaceutical, Kissei Pharmaceutical, Kyowa Kirin, Mallinckrodt Pharmaceuticals, Merck Biopharma, Maruho, Mitsubishi Tanabe Pharma, Nipro Corporation, Novo Nordisk, Nippon Shinyaku, Ono Pharmaceutical, Pfizer, Takeda Pharmaceutical, Taisho Pharmaceutical, and Torii Pharmaceutical. R.K. has nothing to disclose. D.K. received support for the present manuscript (funding and medical writing support funding) from Kyowa Kirin to the author\u2019s institution; and consulting fees from Kyowa Kirin. Y.N. is an employee of Kyowa Kirin. H.I. is an employee of Kyowa Kirin. S.F. received support for the present manuscript (funding and medical writing support funding) from Kyowa Kirin; and consulting fees from Kyowa Kirin. K.O. has received consulting fees, and payment or honoraria from Kyowa Kirin, and served a leadership or fiduciary role in the JSPE.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study was conducted in compliance with the most recent version of the Declaration of Helsinki, and all applicable national regulations in Japan (including the Ethical Guidelines for Medical and Health Research Involving Human Subjects) and South Korea (including local regulations and guidelines). The protocol and the informed consent documentation were approved by the Ethics Committee of Osaka University Graduate School of Medicine, the Ethics Committee of Kyowa Kirin, and the Ethics Committee of each participating medical institution.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research Involving Human Participants and\/or Animals"}},{"value":"Written informed consent was provided by all patients aged 20\u00a0years and older or from the parents or legal representatives of patients aged\u2009<\u200920\u00a0years.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}],"article-number":"50"}}