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A novel large fragment deletion in PLS3 causes rare X-linked early-onset osteoporosis and response to zoledronic acid

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We identified a novel large fragment deletion from intron 9 to 3’UTR in PLS3 (E10-E16del) in one Chinese boy with X-linked early-onset osteoporosis and vertebral fractures, which expanded the pathogenic spectrum of X-linked early-onset osteoporosis. Treatment with zoledronic acid was beneficial for increasing BMD and reshaping the vertebral bodies of this patient.


X-linked early-onset osteoporosis is a rare disease, which is characterized by low bone mineral density (BMD), vertebral compression fractures (VCFs), and/or long bone fractures. We aimed to detect the phenotype and the underlying pathogenic mutation of X-linked early-onset osteoporosis in a boy from a nonconsanguineous Chinese family.


We investigated the pathogenic mutation of the patient with X-linked early-onset osteoporosis by targeted next-generation sequencing and confirmed it by Sanger sequencing. We also observed the effects of zoledronic acid on fracture frequency and BMD of the patient.


Low BMD and multiple VCFs were the main phenotypes of X-linked early-onset osteoporosis. We identified a total of 12,229 bp deletion in PLS3, involving intron 9 to the 3’UTR (E10-E16 del). This large fragment deletion might be mediated by Alu repeats and microhomology of 26 bp at each breakpoint junction. Zoledronic acid treatment could significantly increase the Z-score of BMD and reshape the compressed vertebral bodies.


We identified a large fragment deletion mutation in PLS3 for the first time and elucidated the possible mechanism of the deletion, which led to X-linked early-onset osteoporosis and multiple vertebral fractures. Our findings would enrich the etiology spectrum of this rare disease.

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This study was supported by the National Natural Science Foundation of China (No. 81570802), National Key Research and Development Program of China (No. 2016YFC0901501), and CAMS Initiative for Innovative Medicine (2016-I2M-3-003). We thank the staff in the department of radiology department for measurement of bone mineral density and interpretation of X-ray films. We also thank the boy with PLS3 mutation and his family members for participation in this research. We thank all unaffected, unrelated individuals for providing control DNA samples.

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Correspondence to Z. Qiu or M. Li.

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Figure S

X ray films of the mother, father and sister of the proband. No wormian bones and vertebral compression fractures were observed in his mother (A-B), sister (C-D) and father (E-F). (PPT 2008 kb)

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Lv, F., Ma, M., Liu, W. et al. A novel large fragment deletion in PLS3 causes rare X-linked early-onset osteoporosis and response to zoledronic acid. Osteoporos Int 28, 2691–2700 (2017).

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