The Phosphate Deposition Theory of Fibromyalgia is Not Supported by Medical Evidence
The concept that fibromyalgia is caused by phosphate deposits in tissues due to impaired renal phosphate clearance from genetic defects is not recognized in current medical literature and does not align with the established pathophysiology of fibromyalgia. 1
Actual Pathophysiology of Fibromyalgia
Fibromyalgia is fundamentally a disorder of central pain processing, not a metabolic or renal disorder:
Central sensitization is the core mechanism, involving dysfunction of neuro-circuits that perceive, transmit, and process nociceptive stimuli, resulting in heightened pain responses (hyperalgesia) and pain from non-painful stimuli (allodynia). 2, 3
The condition reflects deficiencies in serotonergic and noradrenergic neurotransmission in the central nervous system, along with increases in pronociceptive neurotransmitters like glutamate and substance P. 3
No organic tissue damage or inflammation is present in fibromyalgia—there are no laboratory abnormalities, tissue deposits, or structural pathology that characterize this syndrome. 4, 5
Why the Phosphate Theory Doesn't Apply
Genetic defects causing impaired renal phosphate clearance produce a completely different clinical picture:
X-linked hypophosphatemia (XLH) is the actual genetic disorder of renal phosphate wasting, caused by PHEX gene mutations leading to elevated FGF23 and subsequent phosphate loss. 6, 7
XLH presents with rickets, osteomalacia, bone deformities, short stature, dental abscesses, and pseudofractures—not the widespread soft tissue pain and fatigue of fibromyalgia. 6
The biochemical profile shows hypophosphatemia with renal phosphate wasting, elevated alkaline phosphatase, and low 1,25(OH)₂D—none of which are features of fibromyalgia. 7
XLH typically manifests in early childhood with skeletal abnormalities, not as adult-onset generalized stiffness. 6
Your Clinical Presentation
Your two-decade history of nightly alcohol use (now stopped) and current symptoms are better explained by:
Post-alcohol withdrawal syndrome can cause persistent fatigue, muscle aches, and sleep disturbances that may persist for months. 1
Fibromyalgia diagnosis requires chronic widespread pain (≥3 months), multiple tender points, fatigue, and non-restorative sleep—which should be evaluated clinically without assuming a phosphate metabolism defect. 1
If fibromyalgia is confirmed, treatment should focus on exercise therapy (the only "strong for" recommendation), with FDA-approved medications like pregabalin or duloxetine for severe symptoms, plus cognitive behavioral therapy. 1
Critical Distinction
Avoid conflating rare genetic phosphate disorders with fibromyalgia—they are entirely separate entities with different mechanisms, presentations, and treatments. If you had a genetic renal phosphate wasting disorder, you would have had childhood skeletal deformities, not adult-onset stiffness. 6, 7