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Living with Familial X-linked hypophosphatemic vitamin D refractory rickets

An inherited condition (XLH) with low blood phosphate that leads to soft, weak bones, bowed legs and dental pain.

Understanding Familial X-linked hypophosphatemic vitamin D refractory rickets

Familial X-linked hypophosphatemic vitamin D refractory rickets, or X-linked hypophosphatemia (XLH), is an inherited disorder with low blood phosphate.

The kidneys lose phosphate in urine, which leads to soft, weak bones (rickets). It is usually diagnosed in childhood. Features include bowed legs, short height, bone pain, and severe dental pain.

Signs & symptoms

Symptoms vary from person to person. GARD lists these among the most common:

  • Bowed legs or knock knees
  • Bone pain
  • Short stature and slow growth
  • Delayed standing and walking
  • Joint pain
  • Dental problems

Not everyone has every symptom. GARD's list comes from the Human Phenotype Ontology.

Diagnosis

  1. Talk with your doctor

    Share the symptoms you've noticed, when they started and your family health history. Notes and photos can help.

  2. See a specialist

    Specialists who may be involved include bone and joint specialists, genetic specialists, hormone specialists and kidney specialists.

  3. Consider genetic testing

    Changes in PHEX are linked to this condition. Genetic testing and counseling can help confirm a diagnosis and explain what it means for your family.

  4. Connect with expert centers

    XLH Network may keep lists of experts for this condition.

Care & treatment

Care team
Bone and joint specialists (orthopedists or orthopedic surgeons); Genetic specialists (geneticists); Hormone specialists (endocrinologists); Kidney specialists (nephrologists)
Expert care
Expert lists: XLH Network
Treatment
GARD doesn't list specific treatments for this condition. Your care team will tailor care to your symptoms.
Research
Clinical trials and observational studies may be options. See the research section below.

General information, not medical advice. Your care team makes the decisions.

Everyday life

Living with a rare condition is easier with support.

  • Connect with XLH Network and other patient organizations
  • Keep notes on symptoms, changes and questions for appointments
  • Ask about patient registries that help research
  • Look into financial aid and travel resources for care visits
Bring these questions to your next doctor visit
Should we have genetic testing for the PHEX gene?
Which specialists should be on my child's care team?
How should my child's bones, growth and teeth be monitored?

Quick facts

Symptoms usually startInfant and as a Child
InheritanceX-Linked
GenesPHEX

Changes in the PHEX gene on the X chromosome cause it. It is X-linked dominant.

GeneticKidneyEndocrine

Also known as: hereditary hypophosphatemic rickets, x-linked; hypophosphatemia, vitamin d-resistant rickets; hypophosphatemic rickets x-linked dominant; hypophosphatemic rickets, x-linked; hypophosphatemic rickets, x-linked dominant; hypophosphatemic rickets, x-linked dominant, x-linked dominant

Patient organizations

Source: NIH GARD · Familial X-linked hypophosphatemic vitamin D refractory ricketsGARD ID 12943 · GARD page updated September 2026 · Plain-language summary by Know Rare; editorial review pending. General information, not medical advice.

You are more than your diagnosis

Perspectives from people navigating life with Familial X-linked hypophosphatemic vitamin D refractory rickets.

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