In particular, among patients harboring pALPL variants, four reported vertebral fractures (two osteoporotic and two osteopenic patients); among patients harboring bALPL variants, five had fragility fractures (two osteoporotic and three osteopenic patients); in the wild-type ALPL group, one patient with osteopenia presented vertebral fractures. This evidence concerns the gene ALPL and Osteopenia.