Bosman Ariadne, Campos-Obando Natalia, Ramakers Christian, Zillikens M Carola
Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, the Netherlands.
Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, the Netherlands.
J Clin Endocrinol Metab. 2025 May 19;110(6):e1885-e1891. doi: 10.1210/clinem/dgae633.
Phosphate is important for several metabolic functions and essential for bone mineralization. Sex differences exist in the relation between serum phosphate and certain diseases. The reference interval for phosphate is age-adjusted in infants, but most institutions use the same intervals for adult men and women despite increasing evidence for age and sex differences.
We aimed to study these differences in 2 large population-based cohorts to evaluate whether current reference intervals are adequate.
A total of 8837 participants from 3 cohorts of the Rotterdam Study (RS) and 422 443 participants from the UK Biobank (UKBB), aged 40 and older and without chronic kidney disease, were analyzed for sex differences in serum phosphate using standard reference values (0.8-1.45 mmol or 2.5-4.5 mg/dL). Analyses were further stratified in women by menopausal status.
Women had higher serum phosphate concentrations and a higher population range compared to men in all cohorts. Hypophosphatemia was more prevalent in men and hyperphosphatemia was more prevalent in women. Sex differences were present in all age categories. Perimenopausal women had higher serum phosphate concentrations than men of the same age, but lower than postmenopausal women of the same age.
This study in 2 population-based cohorts showed that women have higher serum phosphate concentrations than men and that women show a marked increase in serum phosphate during menopause. Moreover, the population range for serum phosphate was higher in women than in men. These findings indicate a need for sex-specific reference intervals for serum phosphate in adults older than 45 years.
磷酸盐对多种代谢功能至关重要，是骨矿化所必需的。血清磷酸盐与某些疾病之间的关系存在性别差异。婴儿的磷酸盐参考区间是根据年龄调整的，但尽管越来越多的证据表明存在年龄和性别差异，大多数机构对成年男性和女性使用相同的区间。
我们旨在研究这两个大型人群队列中的这些差异，以评估当前的参考区间是否合适。
对鹿特丹研究（RS）的3个队列中的8837名参与者和英国生物银行（UKBB）的422443名40岁及以上且无慢性肾病的参与者进行分析，使用标准参考值（0.8 - 1.45 mmol或2.5 - 4.5 mg/dL）评估血清磷酸盐的性别差异。分析进一步按绝经状态对女性进行分层。
在所有队列中，女性的血清磷酸盐浓度更高，人群范围更广。男性低磷血症更普遍，女性高磷血症更普遍。所有年龄组均存在性别差异。围绝经期女性的血清磷酸盐浓度高于同龄男性，但低于同龄绝经后女性。
这项对两个基于人群的队列的研究表明，女性的血清磷酸盐浓度高于男性，并且女性在绝经期间血清磷酸盐显著升高。此外，女性血清磷酸盐的人群范围高于男性。这些发现表明45岁以上成年人需要针对血清磷酸盐的性别特异性参考区间。
