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Perth endocrinologist and chemical pathologist, Dr Paul Glendenning is one of Australia’s leading experts on rare bone diseases.

Here, he talks about the importance of serum phosphate testing, red flags for bone diseases, and early identification and diagnosis of patients with chronic hypophosphataemia.

AusDoc: Serum phosphate is not routinely measured in general practice. Should it be?

Dr Glendenning: I may be showing my age here, but around 40 years ago, we were measuring calcium, phosphate and total alkaline phosphatase routinely as a limited test for musculoskeletal disease. Phosphate was often used as a surrogate measure of vitamin D as this assay wasn’t routinely available, and around that time, the second-generation parathyroid hormone assays (PTH) were also mostly manual assays, so the turnaround time was slow. With more accurate, readily available tests, serum phosphate has probably been a bit forgotten about.  And I will say there are major implications to missing this diagnosis.