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Phosphate + calcitriol is a conventional combination therapy used for the management of X-linked hypophosphatemia (XLH) and related hypophosphatemic rickets. The regimen consists of oral phosphate supplements (sodium-based and/or potassium-based salts) co-administered with calcitriol, the active form of vitamin D (1,25-dihydroxyvitamin D). Phosphate replacement directly addresses renal phosphate wasting, while calcitriol acts through the vitamin D receptor to counteract calcitriol deficiency, prevent secondary hyperparathyroidism, and enhance intestinal phosphate absorption. Although widely used historically to support skeletal mineralization and reduce bone pain, this regimen requires frequent daily dosing and carries risks of long-term complications such as nephrocalcinosis and hyperparathyroidism. It has been largely superseded by burosumab, a targeted anti-FGF23 monoclonal antibody.
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