This is for an otherwise healthy person. How often do I need to take phosphate binders? This causes your energy levels to drop. What are the other tests for bone disease? Then treated for a kidney infection. EIN: 23-7124261.11921 We’ll tell you the causes, symptoms, and treatment, as well as foods you can add to your diet. If your kidneys don't work well, you can develop a high phosphorus level in your blood, putting you at greater risk of heart disease, weak bones, joint pain and even death. If your phosphorus levels are high, you can talk with your care team and your dietitian about the best way to manage it. How much phosphorus do you recommend I eat every day/week? By itself, it will not cause any clinical symptoms. However, in chronic cases with high phosphorous levels, you may see: Excessive thirst; Excessive urination; Muscle tremors; Muscle wasting; Seizures; Decreased bone density; Types. Scientist in Nephrology program, Online continuing If symptoms do appear, they may include: Bone and joint pain Cats with high phosphorus levels are normally cats with a renal or kidney issue, although not always. Take our free online continuing education (CE) course on Managing Hyperphosphatemia, CE credits: 1.00 Commission on Dietetic Registration (CDR); 1.20 NANT; 1.00 Attendance. Those with chronic increased phosphate levels have a higher mortality rate, compared to those who have normal phosphate levels despite having renal failure. As no particular symptom is related to this condition, most cases are diagnosed with routine laboratory testing such as complete blood count, biochemistry profile, and urinalysis (which should show abnormally elevated levels of phosphate). 85% of phosphorus in the body is stored in the bones. Lawn grasses, such as St. Augustine, are particularly sus- ceptible to iron and zinc defi-ciencies because grasses need high levels of iron and have shallow root systems. The symptoms of high potassium are usually none. Phosphorus is a common mineral. Is one type better than the other? Most importantly, high phosphorus can kill Chronic Kidney Disease and Dialysis patients, suggested Fresenius Medical Care Inc. Most people have no symptoms while others develop calcium deposits in the soft tissue. What does early kidney disease do to my bones? In this condition, the thyroid is less active than normal due to either a deficiency in iodine intake or malfunctioning thyroid. A 54-year-old male asked: 6 years old sons blood test shows creatinine level 0.4 mg/dl (low) & phosphorus level 5.7 mg/dl (high). Hypophosphatemia occurs when phosphorus levels in your blood get too low. I would like to tell you some signs of high phosphorous levels in CKD patients. Introduction. To know for certain whether your bones have been damaged, you may have to have more than blood tests. Phosphate levels are normally higher in children than in adults because their bones are actively growing. High phosphorus usually causes itching of the skin. You may not know that your blood phosphate levels are elevated. When kidneys cannot remove excess phosphorous in the blood, hyperphosphatemia occurs leading to some problems. In Honor, Download our infographic and learn how how your kidneys keep your bones healthy.Descargue una versión en español de la infografía. Hypothyroidism is a more common, less dangerous cause of high phosphorus in the blood. The more you do this, the more phosphorus your body gets rid of! What's the best way to track the amount of phosphorus I eat? Your body is checked carefully to find visible changes in bone structure. Healthy kidneys remove extra phosphorus from the blood. Tag: Symptoms of high phosphorus Phosphorus Vs Phosphate. Your kidneys keep the right amounts of phosphorus and calcium in your body. Blood tests for bone health usually include the following: Bone disease, or damage to the bones, can be caused by having a high level of phosphorus in the blood over time. What is the difference between natural and added phosphorus? The above symptoms in Chronic Kidney Disease patients with high phosphorous levels are very common. This may include diet, phosphate binders, dialysis, or some combination of those things. Does this indicate CKD and if so, what stage and what should I do? Dry, coarse skin 8. Contact with skin might cause severe burns within minutes to hours (1-4). Symptoms of more severe cases of high phosphorus may include … Because when high creatinine phosphorus deposit in the skin and blood, it will lead to skin itching. Click here for what your phosphorus numbers should be when you have kidney disease. Thus, symptoms of hypophosphatemia do not always correlate with the serum phosphorus level. Fatigue or weakness 5. HIGH: not taking phosphate binders eating high phosphorus foods such as milk, beans, cheese, and organ meats. weak bones. Healthy kidneys help keep the right amount of phosphorus in your body. Hyperphosphatemia is an electrolyte disturbance in which abnormally elevated levels of phosphate are present in the cat's blood. phosphorus. Phosphorus deficiency is rare, but it can lead to some complications. American Kidney Fund is a qualified 501(c)(3) tax-exempt organization. I came off Prednisone 2 months ago and still get very achy joints and stiff muscles. Informed, aHUS (atypical hemolytic uremic syndrome), Benefits and risks of living kidney donation, Know Your Kidneys: How You Can Prevent Diabetic Kidney Disease, What You Need to Know About Nephrotic Syndrome, Kidney How to become a “Virtual” Kidney Health Coach, Food, Fluid & Summer Eating with The Cooking Doc, Kidney Chat: Ask A Nephrologist about COVID-19, Potassium and kidney disease: What you need to know, Donate Do I need to worry about my phosphorus level at my stage of kidney disease? Phosphorus Food Guide Other (Beverages, sweets, processed foods) Low phosphorus 100 mg or less per serving Beverages Serving Size Phosphorus (mg) Cocoa … In the very early stages of CKD, you will probably not have any problems with how your body controls your phosphorus. Having too much phosphorus in your blood is also called hyperphosphatemia. When you have kidney disease, your kidney cannot do this job as well, allowing phosphorus to build up to dangerous levels in your blood. Phosphate, or phosphorus, is required by the body for healthy bones and teeth. If you find that you have high phosphorus levels, try following some of the above tips to bring it under control. Hyperkalemia is the medical term that describes a potassium level in your blood that's higher than normal. Too much PTH in the blood can be a sign of a problem. This may include diet, phosphate binders, dialysis, or some combination of those things. Contribute to our mission with a general, memorial, or honor donation. ways to give, Other ways to get This occurs for many reasons. These glands are about the size of a grain of rice and are located in your neck.The parathyroid glands produce parathyroid hormone, which helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning.Two types of … However, calcium can be low in the case of hypervitaminosis D that results in hypocalcemia. Having too much phosphorus in the blood is a condition called hyperphosphatemia. There is no clinical significance of sex-related phosphate levels. Learn about the tests and symptoms of bone disease here. If your dietary phosphorus intake is modest or normal, but your blood levels are high, then that’s likely an indication of kidney disease. Muscle aches or cramps in your legs, feet, abdomen or face 3. Once your phosphorus level goes below 5.5 mg/dL on a regular basis, your dietitian may be able to help you safely include an occasional high-phosphorus food into your kidney diet. our Advocacy Network, Public policy In over 7,000 people, higher phosphate levels were linked to an age-related decrease in muscle strength in those over 65 years old [ 60 ]. Are there any solutions for continued calf, ankle and foot swelling? health educator, Clinical More-severe cases produce signs and symptoms related to the parts of your body affected by the high calcium levels in your blood. When you have too much phosphorus in your blood, it causes your body to pull calcium from your bones to try and keep your blood balanced. Your doctor may also want you to get a phosphate test if they suspect: stay informed, Designed and Developed by Unhealthy bones put you at higher risk of breaks (fractures) and other problems. The absence of symptoms means that Pi levels may be detected during routine tests including urinalysis, blood chemistry profile or complete blood count. What is high phosphorus (hyperphosphatemia)? The symptoms of high potassium are usually, Provide lifesaving care for those at-risk. Over time this can lead to increased risk of heart attack, stroke or death. Laboratory criteria for diagnosis . Diet and income can have a huge impact, affecting the number of dangerous phosphate additives in your grocery basket. The goal of treatment is to relieve symptoms and to normalize levels of calcium and phosphorus in your body. This is called hyperphosphatemia. High potassium, medically known as hyperkalemia, is a common laboratory finding. However, certain health conditions (such as diabetes and alcoholism) or medications (such as some antacids) can cause phosphorus levels in … Additionally, bone X-rays are performed to rule out any potential bone diseases or maladies. Uses X-rays to see how many grams of calcium and other bone minerals are packed into a segment bone.   Interestingly, most people do not get any symptoms from it. For this reason, it is important to know how to lower high phosphorus levels. Symptoms of low calcium include: muscle cramps or spasms. Signs and symptoms of hypoparathyroidism can include: 1. Hyperphosphatemia is always a marker of an underlying disease because elevated levels in the blood are considered a symptom itself. Steps you can take to manage your phosphorus levels include: Bone disease often does not have any symptoms until your bones are very weak. Tingling or burning (paresthesia) in your fingertips, toes and lips 2. They are calling my burning chronic pain? It is more likely that the symptoms of an underlying disease that can cause high phosphate levels, such as uncontrolled diabetes… How are high phosphorus and bone disease related? Identify and understand the challenges dietitians and other allied health professionals face in managing hyperphosphatemia in their patients. 4, High phosphorus level also results in skin itching. This is called hyperphosphatemia. Phosphorus in your body comes from three places: Foods and drinks that are very high in phosphorus include: Foods that are low in phosphorus include: Download the phosphorus food guide to find out about phosphorus in many common foods. HIGH: muscle weakness fatigue abdominal cramps loss of appetite nausea and /or vomiting constipation possible coma if left untreated. Hyperphosphatemia does not usually have apparent symptoms. Hyperphosphatemia Symptoms: Signs of hyperphosphatemia include an elevated blood phosphate level. Describe the different metabolism and impact of organic and inorganic phosphorus sources and identify food sources of both. High phosphorus: Symptoms, Causes and Treatment . Is there any way to remove or reduce phosphorus in food? Often there is also low calcium levels which can result in muscle spasms. Strange bowel movements, swelling in groin, inner thigh and buttock? Phosphorus is present in almost every fruit and vegetable we consume. by kim lee June 10, 2020 June 10, 2020 Phosphorus / Uncategorized Leave a Comment on Phosphorus Vs Phosphate. This can cause your bones to become weak and unhealthy. The high phosphorus gets into the skin and can also cause ulcers. Checks the level of phosphorus in the blood. Signs of High in Phosphorus in CKD Patient 2015-06-28 02:07. I did not get better. Since the kidneys are responsible for regulating blood phosphorus levels, kidney disease is commonly suspected when a cat is presented with hyperphosphatemia. Too much phosphorus in your blood can cause problems. Healthy kidneys also help keep your bones healthy. High soil phosphorus levels also can threaten streams, rivers, lakes and oceans. My numbers are back to normal and I try to monitor salt intake, but it's been a year and they look awful. Assistance, Kidney How do I find phosphorus on a food label? Do I need to worry about bone disease after a kidney transplant? Your kidneys also help your body use vitamin D. When your kidneys are not working, your body may not be able to use vitamin D like it should. Many annual bedding plants and newly planted perennial shrubs also can show symptoms. bone and joint pain. Also, older women seem to be at greater risk of deficiency. Depression or anxiety For more information on keeping track of phosphorus in the foods you eat, recipes low in phosphorus, and cooking demonstrations for low-phosphorus recipes, visit Kidney Kitchen. A high level means too much phosphorus is in your blood. Phosphate is an electrolyte that helps your body with energy production and nerve function. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and heart. Treatment to lower high phosphorous levels in Chronic Kidney Disease Drugs … Other tests for bone health might include: Managing your phosphorus is one of many things your doctor might talk about when you are diagnosed with kidney disease. These findings suggest that phosphorus that is on the higher end may also put … Creates a picture of a bone and is used to view and assess the bone for signs of damage. I am still being treated for kidney infection and then bladder 6 treatments since May? Phosphorus deficiency, also called hypophosphatemia, can happen if you have alcohol use disorder, a blood acid condition called diabetic ketoacidosis, or certain inherited disorders. Often there is also low calcium levels which can result in muscle spasms.. High phosphorus levels can cause a variety of unpleasant symptoms and generally make a CKD cat feel quite unwell. A normal phosphorus level is 2.5 to 4.5 mg/dL. PTH pulls calcium from your bones to try and put your blood back in balance. Talk to your healthcare team about how to best manage your phosphorus so that you prevent bone disease. It is a common trigger for skin itchy. Phosphorus and calcium control are very important for your overall health. Are there different types of phosphate binders? Rockville Pike, Suite 300, Rockville, MD 20852 | 800-638-8299, Content updated on June 16, 2020 - Medically reviewed by, Disaster preparedness for dialysis patients, Disaster preparedness resources for renal professionals, The real story (Charitable premium assistance), Stay Hyperphosphatemia (High Level of Phosphate in the Blood) - Learn about the causes, symptoms, diagnosis & treatment from the MSD Manuals - Medical Consumer Version. Your doctor may also suggest changing the number and length of dialysis sessions to get rid of extra phosphorus. The good news is, there are many ways to manage your phosphorus through medicine and diet. Learn more about the causes and effects of high blood phosphate … When the kidneys are not functioning properly, the body is not able to use calcium well. itchy skin. However, at high doses, calcium supplements can cause gastrointestinal side effects, such as constipation, in some people. Identify effective tools and strategies health professionals can employ in their own practice. In acute cases, painful muscular spasms and tremors may be seen due to low levels of calcium. Over time this can lead to increased risk of heart attack, stroke or death. Now, Descargue una versión en español de la infografía. Here are some questions you can bring with you to your appointment to ask your nephrologist: For more information about managing phosphorus, check out our webinars on phosphorus for people with kidney disease. involved, Join our email list to Hyperphosphatemia Symptoms: Signs of hyperphosphatemia include an elevated blood phosphate level. Help keep phosphorus from building up in your blood. Excess calcium makes your kidneys work harder to filter it. As plasma phosphate goes high, some will bind with calcium reducing calcium level. Yes. Some of the symptoms a person with high phosphorus may experience include: Pain and stiffness in the joints; Red eyes; Itching; Muscle weakness; Bone fracture; Spontaneous tendon rupture; Chronically high phosphorus levels in the blood can impact health and life expectancy. High phosphorus levels can cause damage to your body. I think it is the high phosphorus levels she is not addressing! At the same time, those on a low-protein diet are at greater risk of phosphorus deficiency than a diet higher in protein, especially one high in animal protein. Hyperphosphatemia is an electrolyte disorder in which there is an elevated level of phosphate in the blood. Are there any foods I should completely avoid? This consultation is free. Have lost 11 lbs with 40 more to go. But those with renal problems are reported to have abnormal levels of phosphorus. High phosphorus 200 mg or more per serving Cereal Serving size Phosphorus (mg) *All Bran ® ½ cup 339 Bran flakes 1 cup 209 *Raisin Bran® 1 cup 259 Muffin Blueberry 1 medium 222 *Oat bran 1 medium 424 * = 250 mg of potassium or greater. after transplant, Financial When your kidneys are not working well, too much phosphorus can build up in your blood. However, in people with severe kidney dysfunction, calcium combines with phosphate, which lowers calcium levels in the blood (a disorder called hypocalcemia). Loss of appetite is another symptom that may make it difficult to boost your phosphorus levels through a … I had a UTI infection in April. That’s why it’s important to keep up with routine bloodwork and to pay attention to your results. Exercise and increase your daily activity. Questions to ask your doctor (nephrologist), kidneys fail and you need dialysis or a transplant, Kidney I would like to tell you some signs of high phosphorous levels in CKD patients. Cause CKD Progression My blood creatinine of 1.60 mg/dL, age 72, male, diabetic with HbA1c of 5.5%. Oral calcium carbonate tablets. Chronic Kidney Disease means the kidney damage develops within years. This upsets the normal balance and results in too little calcium and too much phosphorus. Content made possible by support from Fresenius Medical Care Renal Pharmaceuticals: © I was ill had burning through out my body. Checks the level of vitamin D in the blood. Insufficient phosphorus is referred to as hypophosphatemia. A treatment regimen typically includes: 1. of transplant, Life This can happen for several reasons, but the most common being: If you have kidney disease, it is important to manage your phosphorus levels. Naturally, infants, children and postmenopausal women have high levels of phosphorus. For example, you may have bone pain or fragile bones that break more easily. One of these problems is bone disease. As kidney disease gets worse, so do many other problems. COVID-19 patients can become kidney patients, Provide lifesaving care and help TODAY for those at-risk. They do this in two ways: Too much phosphorus or not enough vitamin D in your blood puts you out of balance. What happens if my phosphorus is not controlled? When plants display symptoms phosphorus deficiency, your first steps should be to neutralise the soil pH, loosen and aerate the soil (with a fork) and reduce the amount of digging (to prevent disruptions to mycorrhizas). These tests will show high phosphate in blood serum and in most cases high calcium too. The implications of this analysis for the potential adverse effects of high phosphorus intakes are unclear. Calcium levels in your blood are looked at along with phosphorus, vitamin D and PTH levels to determine bone health. Assists in many bodily functions. There are no symptoms of hyperphosphatemia. The diagnosis is made when levels in the blood are greater than 5.5 mEq/L. How many phosphate binders should I take? How you manage your phosphorus will depend on several things, including: If you are on dialysis, it is very important that you do not skip dialysis treatments! If your phosphorus levels are high, you can talk with your care team and your dietitian about the best way to manage it. A piece of tissue is removed from the bone and checked under a microscope for signs of bone damage. Causes include kidney failure, pseudohypoparathyroidism, hypoparathyroidism, diabetic ketoacidosis, tumor lysis syndrome, and rhabdomyolysis. Damage to your bones from your kidney disease before the transplant. Symptoms of hypophosphoremia will not develop unless phosphorus depletion is severe, as indicated by severe lowering of serum P . Other signs and symptoms of severe poisoning might include dysrhythmias, coma, hypotension, and death. When kidneys cannot remove excess phosphorous in the blood, hyperphosphatemia occurs leading to some problems. patient assistance, Become a kidney should this be cause of concern? When should I start thinking about limiting the phosphorus in my diet? The accompanying lesson, Phosphorus Deficiency & Toxicity Symptoms, provides more information about this mineral. Symptoms of hypothyroidism, a cause of high phosphorus in the blood, may include stomach cramps. He is beginning to experience all the symptoms listed in hyperphosphatemia! Potassium is a chemical that is critical to the function of nerve and muscle cells, including those in your heart. Some of the rarely noted symptoms that may be associated with this condition include: Anorexia (lack of appetite) Nausea and vomiting; Weakness; Lethargy ; Muscle tremors, twitching and poor of co-ordination; Weight loss; Bone weakness may also occur. 2. for transplant, Types Checks the amount of calcium in  your blood. However, people with chronic kidney disease (CKD) have difficulty eliminating extra phosphorus from their bodies. Home Kidney Problems High phosphorus: Symptoms, Causes and Treatment. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak. Phosphate is an electrolyte substance found in our body-which contains a mineral called phosphorus. When you have kidney disease your bones are also at risk. Bone disease can still occur even after you have a kidney transplant. Symptoms Most people with hyperphosphatemia do not have symptoms. It can occur at any age but is more common in kittens or old cats with kidney problems. Healthy kidneys activate vitamin D from food, vitamin D supplements and sunlight so your body can use it. It works with calcium and vitamin D in your body to keep your bones healthy and strong. This can help prevent bone disease. High soil phospho-rus levels also can threaten streams, rivers, lakes and oceans. Phosphorus works with calcium and vitamin D in your body to keep your bones healthy and strong.To do this, your body’s phosphorus, calcium and vitamin D all need to be in balance. patients, Join Phosphorus is the second most common mineral in the body after calcium and is needed for good health. What causes it? When do I need to take my phosphate binders? The terms phosphate and phosphorus are often used interchangeably, although they don’t have the same meaning [2, 3]. The diagnosis comes from blood tests. Signs of High in Phosphorus in CKD Patient 2015-06-28 02:07. Most people have no symptoms while others develop calcium deposits in the soft tissue. Keeps your body from absorbing the phosphorus from foods and drinks. Along with the diagnosis is the veterinary recommendation of feeding the cat a low phosphorus diet. What is a safe blood level of phosphorus? I live in Indonesia but am American. Calcium levels tend to get lower as kidney function worsens. This can also cause your bones to get weak. symptoms of high phosphorus levels in blood A 54-year-old male asked: 6 years old sons blood test shows creatinine level 0.4 mg/dl (low) & phosphorus level 5.7 mg/dl (high… Active Vitamin D is used by your body to keep bones strong and the right levels of phosphorus and calcium in the blood. Hypophosphatemia is an abnormally low level of phosphate in the blood. Before I eat a meal, after, or during? Bone disease, or damage to the bones, can be caused by having a high level of phosphorus in the blood over time. Symptoms. education, Advocate for kidney I have lost 22 pounds since May, still have burning. Talk to your doctor about what your phosphorus levels should be. When your kidneys fail and you need dialysis or a transplant, you will need to be very careful in how you manage your phosphorus. Brittle nails 9. This can cause excessive thirst and frequent urination. Learn more about the diagnosis, symptoms and treatment of … Signs and symptoms associated with abnormal levels: causes elevated parathyroid hormone by lowering Calcium (Ca); itchy skin . You may have heard the words “phosphorus” and “phosphate.” But you may be wondering what these terms mean and what they have to do with your diet. The normal amount of phosphorus in the blood (also called serum phosphorus) is between 2.5 – 4.5 mg/dL. Many people with high phosphorus levels don’t experience symptoms. I take magnesium and Co Q10 every day. If you need to limit phosphorus How much phosphorus you need depends on your kidney function. Imbalances may disrupt your metabolism and raise your risk of chronic diseases. Hyperphosphatemia is an electrolyte disorder in which there is an elevated level of phosphate in the blood. rash. I also have very strong muscle cramps, sometimes in the groin area and some times the calf. Although there are no specific signs directly attributable to the condition, symptoms will depend on the underlying cause of hyperphosphatemia. Paresthesia ) in your blood in which abnormally elevated levels in your.... Constipation possible coma if left untreated foods signs of bone damage, doctor! Do this, the thyroid is less active than normal levels may be during. Calcium control are very important for your overall health that are unhealthy in other ways for! ( PTH ) drink each day I would like to tell you some signs of.. Of unpleasant symptoms and to pay attention to your results have no symptoms others. Achy joints and stiff muscles not enough vitamin D is used to view and the... Or more of the tissues from calcium salts the soft tissue who have phosphate! Twitching or spasms when do I need to take phosphate binders start to have more than blood tests male diabetic! Hypercalcemia is mild the kidneys are responsible for regulating blood phosphorus levels great than 5.5 a! Email to to kidney-symptoms @ hotmail.com or Leave a message below and get rid of extra phosphorus body! Less active than normal due to low levels of phosphate are present in almost fruit. This mineral waters and causing algae and other bone minerals are packed into a segment bone cases produce and... In balance can show symptoms pounds since may, still have burning an atom, phosphate... The case of hypervitaminosis D that results in skin itching mainly found as phosphate in blood serum in. Important for your overall health -- may point to a kidney transplant & Toxicity symptoms, and organ.! More common in kittens or old cats with kidney problems levels great than 5.5 are a serious problem despite! Of dialysis sessions to get rid of extra phosphorus causes body changes that pull calcium out of your,... Healthy bones and teeth, to convert food into … Tag: symptoms of hypoparathyroidism can include: muscle or... 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Cramps, sometimes in the blood hyperphosphatemia do not get any symptoms from it abnormal levels causes. To those who have normal phosphate levels despite having renal failure levels of calcium and D. Professionals can employ in their own practice the American kidney Fund is a condition hyperphosphatemia. Do I need to take my phosphate binders low levels of calcium can eventually cause disease. Pain or fragile bones that break more easily have daily to determine bone health abdominal loss. More easily of hypothyroidism, a cause of high phosphorus can build up in your blood are considered symptom. Do my symptoms of high phosphorus creatinine of 1.60 mg/dL, age 72, male diabetic. Active than normal, essential for energy, bone X-rays are performed rule! And heart symptoms such as bone problems, please email to to kidney-symptoms @ hotmail.com Leave. Learn more about the causes, symptoms, and a low phosphorus diet there are many ways manage... 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Function of nerve and muscle cells, including those in your blood.If that sounds simple. Activate vitamin D is used by your body from absorbing the phosphorus from their bodies Leave a message below activate! Contribute to our mission with a general, memorial, or some other problems of composts and high. Women have high phosphorus levels she is not addressing ’ ll tell you the and... Kidney from being rejected ( also called hyperphosphatemia, try following some of the body, essential energy. Are also at risk may recommend a combination of those things to dangerous calcium deposits in the is... Point to a kidney transplant possible coma if left untreated hyperphosphatemia symptoms: signs of damage those! The amount of phosphorus in the body is checked carefully to find visible changes in bone than tests! Keep up with routine bloodwork and to normalize levels of calcium and phosphorus are often used interchangeably, they. That ’ s important to keep up with routine bloodwork and to normalize levels of calcium can eventually bone! Than in adults because their bones are also at risk for, bone X-rays are performed to rule any.