HPP is caused by a defect (mutation) in the gene that makes an enzyme known as tissue nonspecific alkaline phosphatase (TNSALP), resulting in low levels of ALP activity.1,4,5
When ALP is functioning normally, it allows 2 key minerals—calcium and phosphate—to bind together to form healthy, mineralized bones.4,6 In patients with HPP, however, ALP activity is low, leading to insufficient mineralization of bone and altered calcium and phosphate metabolism.7
Many patients with HPP have weak, soft, or brittle bones, as well as skeletal deformities, including HPP-related rickets and bowed legs.1-3,7 These abnormalities can impede growth in children and can continue to impair a person’s mobility.8,9
Infants and young children may experience severe symptoms of HPP, such as respiratory failure, that can lead to premature death or severe breathing complications that require an assistive breathing device.1,9 In a retrospective natural history study of children with severe HPP, those who experienced their first symptom of HPP prior to 6 months of age had a very high mortality rate—73% at 5 years.9
Symptoms of HPP3-7
- Low alkaline phosphatase (ALP) activity
- Reduced bone mineralization
- Muscle weakness
- Respiratory failure due to rachitic chest, leading to premature death in infants
- Fractures and skeletal abnormalities
- Bone/joint/muscle pain
- Developmental delays/impaired mobility