title: Phosphate wasting and fibroblast growth factor-23.
abstract: OBJECTIVE
  The purpose of this study is to review the regulation of phosphate and recent progress in fibroblast growth factor-23 (FGF-23), a key phosphate regulatory hormone.
  
  
  RESULTS
  Phosphate is required for mineralization of bone, muscle strength and a host of biologic functions. Phosphate is sensed by bone that responds with secretion of FGF-23. The major action of FGF-23 is to stimulate phosphaturia. Feedback loops between FGF-23, 1,25-dihydroxyvitamin D3 and parathyroid hormone maintain phosphate homeostasis. Information about FGF-23 has accumulated from studies in patients with oncogenic osteomalacia and inherited disorders of phosphate wasting rickets that explains the pathophysiology. Exciting new discoveries have highlighted FGF-23 as an independent risk factor for cardiovascular disease in patients with chronic kidney disease. The phosphate sensor triggering FGF-23 production remains to be identified.
  
  
  CONCLUSIONS
  Derangements in FGF-23 production, half-life or downstream response are responsible for several disorders of phosphate wasting, rickets and oncogenic osteomalacia. Very high levels of FGF-23 in renal failure are an independent risk for cardiovascular disease.
authors.affiliation: Department of Medicine, Atlanta VA Medical Center and Division of Endocrinology, Lipids, and Metabolism, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Nanes
mesh_terms: D001842:Bone and Bones / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000378:metabolism* / Q000503:physiopathology; D053098:Familial Hypophosphatemic Rickets / Q000378:metabolism* / Q000503:physiopathology; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D010018:Osteomalacia / Q000378:metabolism* / Q000503:physiopathology; D010710:Phosphates / Q000378:metabolism*; D014808:Vitamin D Deficiency
chemical_list: C000717427:FGF23 protein, human; D010710:Phosphates; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23