Here, high ALP activity belonged to the syndrome of MBD because high plasma ALP activity matched elevated bone ALP isoforms, was associated with high levels of osteocalcin and PTH (Table 1), as already described (Kurz et al., 1994; Wolf et al., 2016), and with the presence of arterial calcifications, in line with the literature (London et al., 2005). This evidence concerns the gene PTH and Marchiafava-Bignami disease.