Clinical, radiographic and biochemical characteristics of adult hypophosphatasia
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In this study, we report on clinical, radiographic and biochemical characteristics of 38 patients with adult hypophosphatasia. High-resolution peripheral quantitative computed tomography showed alterations of bone microstructure in a subgroup of 14 patients. Pyridoxal-5-phosphate levels correlated with the occurrence of fractures and the number of symptoms.
Hypophosphatasia (HPP) is a rare disorder with a wide range of clinical manifestations. A reduced enzymatic activity of alkaline phosphatase (ALP) is the key marker of the disease, causing an accumulation of ALP substrates such as pyridoxal-5-phosphate (PLP). The purpose of this retrospective study was to further characterize adult onset HPP.
We assessed clinical, radiographic and laboratory characteristics of 38 adult patients with HPP. Diagnosis of HPP was established by the combination of low-serum ALP, raised PLP levels and typical symptoms and was genetically confirmed in 32 patients. Dual-energy X-ray absorptiometry (DXA) and laboratory data were available in most patients. High-resolution peripheral quantitative computed tomography (HR-pQCT) was performed in 14 patients.
Clinical characteristics included a wide spectrum of symptoms. A history of fracture was present in 15 patients (39%). Twenty-one patients (55%) complained about recurring headaches, 23 patients (61%) had recurring muscle pain, 4 patients (11%) suffered from severe muscle weakness and 18 patients (47%) showed dental abnormalities. Z-scores assessed by DXA were only slightly reduced in most adult HPP patients. HR-pQCT of 14 patients showed microstructural changes of trabecular and cortical bone compared to reference values of healthy subjects. The occurrence of fractures and multiple symptoms (>2 typical HPP symptoms) were associated with significantly elevated levels of PLP.
Adult HPP presents with a wide range of clinical symptoms and is not associated with low bone mass in general. PLP seems to be a good marker for disease severity in adult patients as its level is correlated with the occurrence of fractures and number of symptoms.
KeywordsAlkaline phosphatase ALPL Pyridoxal-5-phosphate Rare bone diseases
Authors’ roles: Study design: TS, HM, FB, WR and MA. Study conduct: TS, HM and FB. Data collection: HM, TR, JH and TH. Data analysis: TS. Drafting manuscript: TS, HM and FB. Approving final version of manuscript: TS, HM, TS, TW, JH, WR, MA and FB. TS takes responsibility for the integrity of the data analysis.
Compliance with ethical standards
The local ethics committee approved the study (PV5272).
Conflict of interest
Tobias Schmidt, Haider Mussawy, Tim Rolvien, Thelonius Hawellek, Jan Hubert, Wolfgang Rüther, Michael Amling and Florian Barvencik declare that they have no conflict of interest. F.B. receives speaker and consultant fees from Alexion, Lilly, and MSD. M.A. receives speaker and consultant fees from Merck.
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