The Diagnosis of Hypophosphatasia

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Hypophosphatasia is a rare genetic bone disorder characterized by osteoblast hyperactivity and bone remodeling with loss of, or incomplete, mineral deposition. It is comparable to osteomalacia and rickets, but maintains a unique set of characteristic identifiers (Mornet 2008; Brickley and Ives 2008). Also called, Rathbun’s Syndrome, hypophosphatasia can be autosomal dominant or autosomal recessive depending on the individual. Severe forms are usually transmitted as autosomal recessive with a recurrence risk of 25 percent, while milder forms can be transmitted as either autosomal dominant or autosomal recessive, with between 25-50 percent recurrence rates (Mornet 2008). Hypophosphatasia has an incidence rate of 1 in 100,000 live births (Brickley and Ives 2008; Wendling et al. 2001). In half of all cases, the condition is fatal.
Mutations within the liver/bone/kidney alkaline phosphatase gene (ALPL) that encodes for tissue non-specific alkaline phosphatase (TNAP) inhibits the mineralization of bone by causing a deficiency of TNAP (Mornet 2008). Regularly, TNAP is dephosphorylated and the inorganic phosphate that is knocked off is used for hydroxyapatite crystallization. If inorganic pyrophosphates (PPi), which are formed when ATP is hydrolyzed into AMP, are not dephosphorylated by TNAP, then hydroxyapatite deposition is inhibited (Mornet 2008).
There are six forms of hypophosphatasia recognized: perinatal lethal; infantile; childhood; adult; odontohypophosphatasia; and perinatal benign. In the first form in utero osteochondral spurs can form on the fore arms and legs (Mornet 2008). The fetus is unable to make it to term and is aborted within few days. The perinatal benign form often shows change in the formation of the spurs but de...

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...cht über die biologisch-anthropologische Literatur 70:249-60.

Brickley, Megan, and Rachel Ives.
2008 The bioarcheology of metabolic bone diseases. Academic Press p 259

Formicola, Vinczeno.
1995 X-linked hypophosphatemic rickets: a probable upper Paleolithic case.
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Hérasse, Muriel with Marc Spentchian, Agnes Taillandier, and Etienne Mornet.
2002 Evidence of a founder effect for the tissue-nonspecific alkaline phosphatase (TNSALP) gene E174K mutation in hypophosphatasia patients. European Journal of Human Genetics. 10(10):666-8.

Mornet, Etienne
2008 Hypophosphatasia. Best Practice & Research Clinical Rheumatology

Wendling, Daniel with Laurence Jeannin-Louys, Patrick Kremer, Florence Fellmann, Éric Toussirot and Étienne Mornet
2001 Adult Hypophosphatasia. Current Aspects. Joint Bone Spine 68(2):120-124

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