The diverse clinical phenotypes induced by ENPP1 deficiency—vascular calcifications, vascular intimal endothelial cell hyperplasia, FGF23 mediated phosphate wasting rickets, osteoporosis, enthesis calcifications, spinal fusion, and hearing loss—are unlikely to be addressed by a single therapeutic intervention, or even a combination of interventions. The gene discussed is ENPP1; the disease is osteoporosis.