Balance Phosphorus Levels for Healthier Bones, Teeth & More!

The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.

Phosphorus and phosphate both refer to the same thing when talking about testing, which is the measurement of inorganic phosphate level in the blood (serum phosphorus/phosphate test).

Phosphorous is a mineral widely distributed in the body, primarily in teeth and bones. When phosphorous combines with other substances, the result is either an organic or inorganic compound. Inorganic phosphates are salts of phosphoric acid with metal ions.

Importance of Tracking Inorganic Phosphate

Phosphorous is a crucial dietary nutrient. Your body needs inorganic phosphate for energy production, muscle and nerve function, bone and dental formation, nucleic acid production, and serves as a buffer to maintain our acid-base balance. Only 1% of your total phosphate is present in the blood, whereas nearly 80% of it is found in the bones and teeth.

Inorganic phosphate levels in your blood are maintained within a narrow range through a complex network of regulations and feedback loops that involve the parathyroid glands, kidneys, intestines, and bones. Together they determine the amount of phosphorous absorbed in your bowel, excreted in the urine, and circulate in the blood. Parathyroid hormones, calcium and vitamin D levels will determine the concentration of blood phosphorous.

Abnormally high or low levels of inorganic phosphate are associated with different diseases hence the importance of tracking this biomarker. This is particularly important for persons with kidney and gastrointestinal diseases, as they are more likely to suffer from either malabsorption, excess loss through urine, etc.

Signs and Symptoms to Watch Out For

Mild to moderate hypo- and hyperphosphatemia often do not have any symptoms. Since they are often the result of some underlying disease process, early stage symptoms and signs if present tend to be non-specific or related to the underlying disease. However, the more typical symptoms and signs to be aware are as below.


Hypophosphatemia refers to inorganic phosphate deficiency and can be caused by numerous factors including burns, hypercalcemia, starvation, alcoholism, chronic kidney disease and diuretic use. About 2% of hospitalised patients have hypophosphatemia.

Phosphate deficiency is usually asymptomatic, but when symptoms do occur they are:

  • Muscle weakness
  • Osteomalacia (weakening of the bones)
  • Confusion
  • Seizures


Hyperphosphatemia refers to excessive levels of inorganic phosphate in the body. Hyperphosphatemia is less commonly seen, and usually caused by chronic kidney disease, hypoparathyroidism (low parathyroid hormones), and acidosis (such as diabetic ketoacidosis).

Symptoms associated with high phosphate (usually occurs when levels are severely high):

  • Muscle spasms or cramps
  • Itchy skin and rash
  • Confusion
  • Bone and joint pain and discomfort
  • Numbness and tingling around the mouth
  • Weak bones

Consequences of Having Abnormal Phosphorous Levels

Both hypo- and hyperphosphatemia can cause various complications when left untreated. The following are problems that are linked with inorganic phosphate deficiency:

  • Weak bones and fractures – bearing in mind that 70-80% of the body’s phosphates combine with calcium to form bones and teeth, deficiency in this element makes your bones weak and prone to fractures
  • Rhabdomyolysis – about 10% of body’s phosphates are found in your muscles, and a deficiency in this element can lead to rhabdomyolysis, the breakdown of damaged skeletal muscle and death of muscle tissue
  • Dental cavities: phosphorous is just as important as calcium for healthy teeth. Insufficient phosphorous leads to inadequate teeth formation and maintenance.
  • Hemolytic anaemia – a condition wherein red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over
  • Arrhythmia – an irregular heart rhythm

Complications associated with excessive levels of inorganic phosphate are:

  • Osteoporosis – condition indicated by weak, fragile bones prone to fractures. Osteoporosis is more prevalent among women than in men. About 200 million women in the world have this condition
  • Kidney damage – high levels of phosphorous can lead to accumulation of calcium deposits in the soft tissues like the kidneys causing renal damage if left unchecked.

Ways to Balance Phosphorous Levels

Proper management of both hypo- and hyperphosphatemia is crucial for health and prevention of the above-mentioned complications. Deficiency in phosphate is usually managed by increasing intake of foods that are rich in this element, but supplements are also helpful. Your doctor may also recommend increasing consumption of vitamin D as well. For severe cases of deficiency, getting high doses of phosphate through IV may be required.

On the other hand, management of hyperphosphatemia requires lowering consumption of phosphate. Bearing in mind that adjusting your diet may not be enough, your doctor could recommend dialysis to fix the problem. Doctors may also prescribe medications that help your body get rid of excess phosphate.

When to See the Doctor

If you have kidney disease, gastrointestinal problems, or issues with your liver it’s a good idea to see your doctor and ask about an inorganic phosphate test. This is particularly important because in many cases both deficiency and excessive phosphate tend to be asymptomatic. However, if you notice any symptom mentioned above, consult your doctor as well.

Further Testing to Do to Check for Ailments Linked to Phosphorous

Besides checking levels of this biomarker, there are other tests your doctor may order to check for conditions that are associated with inorganic phosphate. These tests are:

  • Parathyroid hormone (PTH)
  • Calcium
  • Vitamin D
  • Kidney function test (serum urea, creatinine, eGFR)
  • Imaging tests (X-ray, MRI, CT scan) for your bones


Inorganic phosphate is vital for your health and wellbeing. It’s easy to balance levels of this mineral with a healthy diet, but sometimes people can have a deficiency or excessive concentration of inorganic phosphate. Both these conditions can cause numerous complications and they are usually asymptomatic until severe. If you have liver, kidney, or parathyroid problems including weak bones, then checking levels of this biomarker is crucial. Stay vigilant.

If you want to find out more about phosphorus and how to maintain healthy levels of it, take a look at our lifestyle article here!

Interested in other biomarkers? Check out the rest of The Biomarker Handbook.

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