Given that the symptomatology of Phospho1−/− mice (osteomalacia, spontaneous fractures, scoliosis) resembles many of the manifestations of HPP, we propose that a subset of individuals with HPP-like manifestations that resist diagnosis (i.e., some in the pseudo-HPP group) could potentially carry unreported pathogenic PHOSPHO1 variants. Here, PHOSPHO1 is linked to scoliosis.