skip to main content

Adult hypophosphatasia — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardMetabolic bone diseaseAdult hypophosphatasiaSCE Rheumatology

A 46-year-old woman has recurrent metatarsal stress fractures, early loss of adult teeth and chronic musculoskeletal pain. ALP is persistently low on repeated testing, phosphate is high-normal and vitamin D is sufficient. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Adult hypophosphatasia

Persistently low ALP with stress fractures and premature tooth loss suggests adult hypophosphatasia. Paget disease usually raises ALP, and primary hyperparathyroidism causes hypercalcaemia with high PTH. Recognising hypophosphatasia matters because bisphosphonates may worsen atypical fracture risk.

Reference: BSR rheumatology curriculum; metabolic bone disease reviews