Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Mar 28;116(1):56.
doi: 10.1007/s00223-025-01363-z.

Office Blood Pressure and Obesity in Children with X-Linked Hypophosphatemia

Ineke Böckmann  1 , Maren Leifheit-Nestler  1 , Mirko Rehberg  2 , Giuseppina Spartà  3 , Katrina Evers  3 , Karl Peter Schlingmann  4 , Markus J Kemper  5 , Annette Richter-Unruh  6 , Olaf Hiort  7 , Karina Grohmann-Held  8 , Ute Derichs  9 , Clemens Freiberg  10 , Marcus Weitz  11 , Desiree Dunstheimer  12 , Elmar Schmid  13 , Ulrike John-Kroegel  14 , Oliver Metzing  15 , Sabine Heger  16 , Norbert Jorch  17 , Hagen Staude  18 , Ludwig Patzer  19 , Elke Wühl  20 , Miroslav Zivicnjak  1 , Dirk Schnabel  21 , Dieter Haffner  22 ; German Society for Pediatric Nephrology (GPN) and the German Society for Pediatric and Adolescent Endocrinology and Diabetology (DGPAED)
Affiliations
Observational Study

Office Blood Pressure and Obesity in Children with X-Linked Hypophosphatemia

Ineke Böckmann et al. Calcif Tissue Int. .

Abstract

X-linked hypophosphatemia (XLH) is the most common inherited form of hypophosphatemic rickets. Children with XLH have an increased risk of obesity, which may promote high blood pressure, but data on blood pressure in XLH are inconclusive. We aimed to assess blood pressure and its determinants in pediatric XLH patients. We conduct a prospective, multicenter observational study of children with XLH in Germany and Switzerland. Office blood pressure and body mass index (BMI) were annually measured in 128 pediatric XLH patients with a median follow-up of 2 years (range 1-6). Potential predictors of blood pressure were investigated by Spearman correlation. Seventeen percent of patients were treated with phosphate supplements and active vitamin D for a median of 8 years, 83% of patients received burosumab for 2.3 years with 3.1 years of prior treatment with phosphate supplements and active vitamin D. Median systolic (0.75 z-score) and diastolic (0.32 z-score) blood pressure and BMI (0.72 z-score) were increased compared to healthy children (each p < 0.01). The prevalence of obesity (9.8% vs. 3%), arterial hypertension (26.2% vs. 5%), and high-normal blood pressure (22.9% vs. 5%) was higher in the XLH cohort compared to the general pediatric population (each p < 0.001). Spearman rank correlation analysis revealed significant associations between both systolic (r = 0.24; p < 0.01) and diastolic (r = 0.20; p < 0.05) blood pressure with BMI, while the mode of treatment, i.e. burosumab versus phosphate supplements and active vitamin D, was no significant correlate. Children with XLH present with elevated office blood pressure values, associated with elevated BMI.

Keywords: Blood pressure; Body mass index; Burosumab; Hypertension; X-linked hypophosphatemia.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: Dieter Haffner, Oliver Metzing, Annette Richter-Unruh and Dirk Schnabel received speaker fees, consultation fees, and research grants from Kyowa Kirin. Mirko Rehberg received speaker fees and consultation fees from Kyowa Kirin. Ulrike John-Kroegel, Maren Leifheit-Nestler and Ludwig Patzer received speaker fees from Kyowa Kirin. Ineke Böckmann, Giuseppina Spartà, Katrina Evers, Karl Peter Schlingmann, Markus J. Kemper, Olaf Hiort, Karina Grohmann-Held, Ute Derichs, Clemens Freiberg, Marcus Weitz, Desiree Dunstheimer, Elmar Schmid, Sabine Heger, Norbert Jorch, Hagen Staude, Elke Wühl, Miroslav Zivicnjak declare no conflict of interest. Ethical Approval: This study/registry was assessed and approved by the ethics committee of the Institutional Ethics Review Board at Hannover Medical School (No. 7259) and from each participating center and was performed according to the Declaration of Helsinki. Consent to Participate: Patients and/or parents/guardians provided written informed consent and assent to participate in the study.

Figures

Fig. 1
Fig. 1
The patient cohort: Annual blood pressure measurements were available in 128 out of the 147 patients included in the XLH registry, with a median follow-up of 2 years (range 6). Of these, 22 were treated with phosphate supplements and active vitamin D, and 106 were on burosumab treatment
Fig. 2
Fig. 2
Systolic blood pressure (a), diastolic blood pressure (b) and body mass index (c) z-scores in pediatric XLH patients on treatment with phosphate supplements and vitamin D or burosumab. *p < 0.05 versus healthy children; **p < 0.01 versus healthy children; ****p < 0.001 versus healthy children. P + vit.D, phosphate supplements and active vitamin D; Buro burosumab, SBP systolic blood pressure, DBP diastolic blood pressure, BMI body mass index
Fig. 3
Fig. 3
Prevalence of overweight, obesity, hypertension and high-normal blood pressure in the XLH patient cohort versus the German general pediatric population [28]. P values were calculated using Chi-squared test. *p < 0.01; **p < 0.001. XLH X-linked hypophosphatemia, GP German general pediatric population, BP blood pressure
Fig. 4
Fig. 4
Systolic (a) and diastolic (b) blood pressure as a function of BMI in 128 pediatric XLH patients on treatment with phosphate supplements and active vitamin D or burosumab. A: r = 0.239, p = 0.007; B: r = 0.200, p = 0.024. BP, blood pressure; BMI, body mass index
See this image and copyright information in PMC

References

    1. Carpenter TO, Imel EA, Holm IA, Jan de Beur SM, Insogna KL (2011) A clinician’s guide to X-linked hypophosphatemia. J Bone Miner Res 26:1381–1388. 10.1002/jbmr.340 - PMC - PubMed
    1. Beck-Nielsen SS, Brock-Jacobsen B, Gram J, Brixen K, Jensen TK (2009) Incidence and prevalence of nutritional and hereditary rickets in southern Denmark. Eur J Endocrinol 160:491–497. 10.1530/eje-08-0818 - PubMed
    1. Endo I, Fukumoto S, Ozono K, Namba N, Inoue D, Okazaki R, Yamauchi M, Sugimoto T, Minagawa M, Michigami T, Nagai M, Matsumoto T (2015) Nationwide survey of fibroblast growth factor 23 (FGF23)-related hypophosphatemic diseases in Japan: prevalence, biochemical data and treatment. Endocr J 62:811–816. 10.1507/endocrj.ej15-0275 - PubMed
    1. Beck-Nielsen SS, Mughal Z, Haffner D, Nilsson O, Levtchenko E, Ariceta G, de Lucas CC, Schnabel D, Jandhyala R, Mäkitie O (2019) FGF23 and its role in X-linked hypophosphatemia-related morbidity. Orphanet J Rare Dis 14:58. 10.1186/s13023-019-1014-8 - PMC - PubMed
    1. Haffner D, Emma F, Eastwood DM, Duplan MB, Bacchetta J, Schnabel D, Wicart P, Bockenhauer D, Santos F, Levtchenko E, Harvengt P, Kirchhoff M, Di Rocco F, Chaussain C, Brandi ML, Savendahl L, Briot K, Kamenicky P, Rejnmark L, Linglart A (2019) Clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia. Nat Rev Nephrol 15:435–455. 10.1038/s41581-019-0152-5 - PMC - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources