Screening for hypophosphatasia may prevent complications in Fibromyalgia
Hypophosphatasia refers to incomplete or defective bone mineralization due to ALP gene mutation, which causes low levels of ALP. The Disease has a heterogeneous presentation presenting as a chronic pain syndrome like fibromyalgia (FM). Patil Injean, in a recent study, found that the % of patients with fibromyalgia (FM) found to have consistently low alkaline phosphatase (ALP) levels was 9.3%. None of these patients had vitamin B6 levels or genetic testing, suggesting that a hypophosphatasia (HPP) diagnosis was not suspected. Given the availability of enzyme replacement therapy to prevent complications from HPP, such as fractures, it is vital to diagnose HPP. This study supported the inclusion of HPP screening as part of the initial evaluation of FM.
The co-researcher of this study Could Some Patients With Fibromyalgia Potentially Have Hypophosphatasia? A Retrospective Single-Center Study is John Tan, and the research is published in ACR Open Rheumatology.
No studies yet have investigated levels of ALP in Fibromyalgia patients. Previous research has identified adult-onset HPP in patients with a prior diagnosis of FM. Previous case reports have reported the incidence of adult-onset HPP in patients who were initially diagnosed with FM. Researchers determined whether there are any potential patients with HPP in the group of patients previously diagnosed with FM. The usage of Antiresorptive therapy can trigger atypical femur fractures in HPP patients.
The researchers reported the following findings:
- A total of Six hundred eleven FM patients were identified.
- Two hundred had at least one low ALP level, and 57 had at least three consecutively low measurements of ALP.
- 44% reported fracture history.
- Vitamin B6 levels were not checked in the patients.
- None of the patients had previous genetic testing for HPP or underwent testing for zinc or magnesium levels.
Concluding further, they said, “Based on the study’s findings, the percentage of patients with FM who were found to have consistently low ALP levels was 9.3%. Our study has highlighted an essential consideration that it is crucial to diagnose HPP, given the availability of enzyme replacement therapy to prevent complications from HPP, such as fractures. “
The researchers recognized several limitations in the study, including the small sample size of patients with three consecutive low readings of ALP below the reference range, the retrospective design of the study, and the lack of ability to perform genetic testing on patients suspected of having HPP.
Further reading:
https://acrjournals.onlinelibrary.wiley.com/doi/full/10.1002/acr2.11591
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