The present first-line agents, including bisphosphonates (BPS), selective estrogen receptor modulators (SERM), parathyroid hormone (PTH) and denosumab, might inevitably lead to a series of adverse effects, such as myasthenia gravis, osteonecrosis and tumorigenesis, along with long-term usage in treatment of osteoporosis3. Here, ESR1 is linked to myasthenia gravis.