{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T15:55:47Z","timestamp":1792166147599,"version":"4.4.0"},"reference-count":55,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2014,1,20]],"date-time":"2014-01-20T00:00:00Z","timestamp":1390176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,7,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2003<\/jats:title>\n                  <jats:p>A serum alkaline phosphatase value below the age-adjusted lower limits of normal (hypophosphatasemia) is uncommonly encountered in clinical practice. The electronic and paper medical records of 885,165 patients treated between 2002 and 2012 at a large, rural, multispecialty health clinic were interrogated to estimate the prevalence and characterize the clinical and radiographic findings of adults whose serum alkaline phosphatase was almost always low (persistent hypophosphatasemia). We hypothesized that some of these patients might harbor previously unrecognized hypophosphatasia, a rare, inherited condition of impaired mineralization of bones and teeth. Persistent hypophosphatasemia (serum alkaline phosphatase \u226430 IU\/L) was found in 1 of 1544 adult patients. These adult patients had more crystalline arthritis, orthopedic surgery, chondrocalcinosis, calcific periarthritis, enthesopathy, and diffuse idiopathic skeletal hyperostosis than a general adult patient population. A gender effect was observed. The clinical and radiographic findings of adult patients with persistent hypophosphatasemia resemble those of the adult form of hypophosphatasia. Clinicians should take notice of persistent hypophosphatasemia, consider the diagnosis of hypophosphatasia, and be cautious when considering potent anti-remodeling therapy in these adults. This population warrants further evaluation. \u00a9 2014 American Society for Bone and Mineral Research.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/jbmr.2178","type":"journal-article","created":{"date-parts":[[2014,1,20]],"date-time":"2014-01-20T06:12:40Z","timestamp":1390198360000},"page":"1651-1660","source":"Crossref","is-referenced-by-count":85,"title":["Clinical and Radiographic Findings in Adults With Persistent Hypophosphatasemia"],"prefix":"10.1093","volume":"29","author":[{"given":"Fergus Eoin","family":"McKiernan","sequence":"first","affiliation":[{"name":"Center for Bone DiseaseMarshfield ClinicMarshfieldWIUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard L","family":"Berg","sequence":"additional","affiliation":[{"name":"Biomedical Informatics Research CenterMarshfield Clinic Research FoundationMarshfieldWIUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Fuehrer","sequence":"additional","affiliation":[{"name":"Biomedical Informatics Research CenterMarshfield Clinic Research FoundationMarshfieldWIUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2014,1,20]]},"reference":[{"key":"2024020318513309400_jbmr2178-bib-0001","doi-asserted-by":"crossref","DOI":"10.1002\/3527608060","volume-title":"Mammalian alkaline phosphatases: from biology to applications in medicine and biotechnology","author":"Mill\u00e1n","year":"2006"},{"key":"2024020318513309400_jbmr2178-bib-0002","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/B978-0-12-387829-8.00022-6","volume-title":"Genetics of bone biology and skeletal disease","author":"Whyte","year":"2013"},{"key":"2024020318513309400_jbmr2178-bib-0003","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/978-1-4613-2970-1_9","volume-title":"Alkaline phosphatase","author":"McComb","year":"1979"},{"key":"2024020318513309400_jbmr2178-bib-0004","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1093\/clinchem\/41.4.515","article-title":"Significance of low alkaline phosphatase activity in a predominantly adult male population","volume":"41","author":"Lum","year":"1995","journal-title":"Clin Chem."},{"key":"2024020318513309400_jbmr2178-bib-0005","first-page":"9","article-title":"Clinical significance of a low serum alkaline phosphatase","volume":"40","author":"Macfarlane","year":"1992","journal-title":"Neth J Med."},{"key":"2024020318513309400_jbmr2178-bib-0006","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s00198-013-2447-x","article-title":"Acute hypophosphatasia","volume":"25","author":"McKiernan","year":"2014","journal-title":"Osteoporos Int."},{"key":"2024020318513309400_jbmr2178-bib-0007","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1002\/9781118453926.ch101","volume-title":"Primer on the metabolic bone diseases and disorders of mineral metabolism","author":"Whyte","year":"2013","edition":"8th ed"},{"key":"2024020318513309400_jbmr2178-bib-0008","article-title":"Clinical utility gene card for: hypophosphatasia\u2014update 2013","author":"Mornet","year":"2013","journal-title":"Eur J Hum Genet."},{"key":"2024020318513309400_jbmr2178-bib-0009","author":"Mornet"},{"key":"2024020318513309400_jbmr2178-bib-0010","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1172\/JCI117814","article-title":"Alkaline phosphatase: placental and tissue-nonspecific isoenzymes hydrolyze phosphoethanolamine, inorganic pyrophosphate, and pyridoxal-5-phosphate. 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