Journal of Bone and Mineral Metabolism

, Volume 30, Issue 1, pp 10–18 | Cite as

Can features of phosphate toxicity appear in normophosphatemia?

Invited Review


Phosphate is an indispensable nutrient for the formation of nucleic acids and the cell membrane. Adequate phosphate balance is a prerequisite for basic cellular functions ranging from energy metabolism to cell signaling. More than 85% of body phosphate is present in the bones and teeth. The remaining phosphate is distributed in various soft tissues, including skeletal muscle. A tiny amount, around 1% of total body phosphate, is distributed both in the extracellular fluids and within the cells. Impaired phosphate balance can affect the functionality of almost all human systems, including muscular, skeletal, and vascular systems, leading to an increase in morbidity and mortality of the involved patients. Currently, measuring serum phosphate level is the gold standard to estimate the overall phosphate status of the body. Despite the biological and clinical significance of maintaining delicate phosphate balance, serum levels do not always reflect the amount of phosphate uptake and its distribution. This article briefly discusses the potential that some of the early consequences of phosphate toxicity might not be evident from serum phosphate levels.


Klotho FGF23 Vitamin D Calcium 



Some of the original research that formed the basis of this review article was performed by Drs. Mutsuko Ohnishi (MD, PhD), Shigeko Kato, (PhD), Junko Akiyoshi, (MD), Kazuyoshi Uchihashi, (MD, PhD), Khadijah Turkistani (BDS), and Yonggeun Hong (PhD) of the Department of Oral Medicine, Infection and Immunity at the Harvard School of Dental Medicine, Boston, MA, USA, and supported by a grant (R01-DK077276 to M.S. Razzaque) from the National Institute of Diabetes and Digestive and Kidney Diseases.

Conflict of interest



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© The Japanese Society for Bone and Mineral Research and Springer 2012

Authors and Affiliations

  1. 1.Department of Oral Medicine, Infection and ImmunityHarvard School of Dental MedicineBostonUSA
  2. 2.Department of PathologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan

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