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An Australian pathology audit has revealed that nearly 60% of patients with hypophosphataemia miss out on follow-up testing, raising concern that serious underlying conditions, including X-linked hypophosphataemia (XLH), are being missed or diagnosed late.

“Recognition and appropriate treatment of hypophosphataemia requires clinicians to be aware of the importance of testing phosphate when clinically indicated and the need for follow-up investigation,” write the authors.

Their audit, published in the August 2025 issue of Pathology, focused on patients for whom phosphate testing had been intentionally and specifically requested. They examined more than 61,000 serum phosphate results from a major community laboratory in Perth. Of these, 644 results (1.04%) showed a phosphate level below 0.7 mmol/L, the study’s threshold for hypophosphataemia. After exclusions, 179 individual patients were identified with low phosphate. Yet 106 of them (59%) had no repeat phosphate test within six months.