ALPL and hypophosphatasia: While recessive mutations of the TNSALP gene give rise to a more severe diseases manifesting early in childhood, adult hypophosphatasia is a genetically determined disorder of mineralization, usually determined by haploinsufficiency of TNSALP, in which osteomalacia in a part of a more complex clinical picture, characterized by multiple insufficiency fractures, chondrocalcinosis, osteoarthropathy, and dental abnormalities (early loss of primary and secondary teeth).