FGF23 and hypophosphatemia: PMT cells excessively express FGF-23, which inhibits phosphate reabsorption in the renal tubules and the conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D3, causing substantial phosphate loss in urine, leading to hypophosphatemia and osteomalacia (Bowe et al., 2001; Florenzano et al., 2021).