For instance, we consider it reasonable to diagnose the 14‐year‐old girl with a persistent BME in the tibia diaphysis as an HPP patient because the localization is very unusual for the occurrence of a BME.28 However, this case also illustrates the difficulty in distinguishing ALPL mutation carriers from HPP patients.29 As the persistent BME was the only symptom at the time of occurrence, the patient might also be considered a mutation carrier by other physicians. Here, ALPL is linked to hypophosphatasia.