Age-Specific Centiles for Fibroblast Growth Factor 23 and Its Associations with Mineral and Bone Metabolism in Healthy Children

Piec, Isabelle, Chu, Andre, Nichols, Ben, Lewis, Carianne, Thoroughgood, Christopher W., Gerasimidis, Konstantinos, Schoenmakers, Inez, Dunn, Rachel, Tang, Jonathan C. Y., Chipchase, Alison, Fraser, William D. and Webb, Emma A. (2026) Age-Specific Centiles for Fibroblast Growth Factor 23 and Its Associations with Mineral and Bone Metabolism in Healthy Children. Journal of Steroid Biochemistry and Molecular Biology. ISSN 0960-0760 (In Press)

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Abstract

Background: Fibroblast Growth Factor 23 (FGF23) regulates phosphate and vitamin D metabolism and is implicated in pediatric disorders such as X-linked hypophosphatemia and CKD–mineral and bone disorder. Accurate interpretation in children requires age-adjusted centile charts. Objective: To construct age- and sex-specific centile charts for intact (iFGF23) and C-terminal (cFGF23) FGF23 in healthy UK children and examine associations with mineral and bone metabolism markers. Methods: In a cross-sectional cohort of 430 children aged 0–16 years, plasma iFGF23 and cFGF23 were measured using DiaSorin and Quidel immunoassays. Age-specific centiles (2.5th–97.5th) were generated using GAMLSS modeling. Serum phosphate, albumin-adjusted calcium (AdCa), vitamin D metabolites, PTH, and bone turnover markers (PINP, CTX, NTX, BAP) were assessed. Associations were evaluated using LN-transformed regression and Pearson correlations. Results: FGF23 concentrations declined with age, with highest values in infancy. At 2 years, median iFGF23 was 43.0 pg/mL (2.5–97.5th centiles: 20.8–81.6 pg/mL), while by 16 years, the median remained 42.9 pg/mL (20.8–81.5 pg/mL). For C-terminal FGF23 (cFGF23), the median was 98.2 RU/mL (2.5–97.5th centiles: 47.0-225.4 RU/mL) at 2 years and 80.2 RU/mL (38.4–184.1 RU/mL) at 16 years (p < 0.001). Correlation analyses showed weak but statistically significant associations of cFGF23 with PINP (r = 0.199, p < 0.001) and NTX (r = 0.150, p =0.005), while iFGF23 exhibited similar weak correlations, with PINP (r = 0.120, p < 0.016) and BAP (r = 0.121, p = 0.013). Conclusion: We constructed age-specific centile charts for iFGF23 and cFGF23 in healthy children required for the interpretation of FGF23 in clinical practice and to provide a foundation for improved management of pediatric disorders in phosphate and vitamin D metabolism. Phosphate was the strongest predictor of both iFGF23 and cFGF23. Age and 25OHD predicted iFGF23 but not cFGF23. Both were correlated with markers of bone metabolism.

Item Type:	Article
Uncontrolled Keywords:	fibroblast growth factor 23,intact fgf23,c-terminal fgf23,pediatric reference ranges,centiles,phosphate
Faculty \ School:	Faculty of Science > School of Biological Sciences Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Musculoskeletal Medicine Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health Faculty of Medicine and Health Sciences > Research Groups > Nutrition and Preventive Medicine Faculty of Medicine and Health Sciences > Research Centres > Public Health
Depositing User:	LivePure Connector
Date Deposited:	16 Apr 2026 10:36
Last Modified:	16 Apr 2026 10:36
URI:	https://ueaeprints.uea.ac.uk/id/eprint/102787
DOI:	issn:0960-0760

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