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Variable Bone Phenotypes in Patients with Pseudohypoparathyroidism

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Abstract

Purpose of Review

Pseudohypoparathyroidism (PHP) is a disorder caused by mutations and/or epigenetic changes at the complex GNAS locus. It is characterized by hypocalcemia, hyperphosphatemia, and an elevated parathyroid hormone concentration secondary to the resistance of target tissues to the biological actions of parathyroid hormone. PHP is divided into several subtypes with different yet overlapping phenotypes. Research on the bone status in patients with PHP is sparse and has yielded inconsistent results. This review was performed to summarize the current knowledge on the bone phenotypes and possible mechanisms of PHP.

Recent Findings

Patients with PHP exhibit highly variable bone phenotypes and increased concentrations of bone turnover markers. Long-standing elevation of the parathyroid hormone concentration may lead to hyperparathyroid bone diseases, including rickets and osteitis fibrosa. Compared with normal controls, patients with PHP may exhibit similar, increased, or decreased bone mineral density. Higher bone mineral density has been found in patients with PHP type 1A than in normal controls, whereas decreased bone mass, osteosclerosis, and osteitis fibrosa cystica have been reported in patients with PHP type 1B, indicating more variable bone phenotypes in PHP type 1B.

Summary

Bone tissues show partial sensitivity to parathyroid hormone in patients with PHP, leading to heterogeneous reactions to parathyroid hormone in different individuals and even in different regions of bone tissues in the same individual. Regions rich in cancellous bone are more sensitive and show more obvious improvement after therapy. Active vitamin D and calcium can significantly improve abnormal bone metabolism in patients with PHP.

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Data Availability

The data are available from the corresponding author upon reasonable request.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Mantovani G, Bastepe M, Monk D, de Sanctis L, Thiele S, Usardi A, Ahmed SF, Bufo R, Choplin T, De Filippo G, Devernois G, Eggermann T, Elli FM, Freson K, Garcia Ramirez A, Germain-Lee EL, Groussin L, Hamdy N, Hanna P, Hiort O, Juppner H, Kamenicky P, Knight N, Kottler ML, Le Norcy E, Lecumberri B, Levine MA, Makitie O, Martin R, Martos-Moreno GA, Minagawa M, Murray P, Pereda A, Pignolo R, Rejnmark L, Rodado R, Rothenbuhler A, Saraff V, Shoemaker AH, Shore EM, Silve C, Turan S, Woods P, Zillikens MC, Perez de Nanclares G, Linglart A. Diagnosis and management of pseudohypoparathyroidism and related disorders: first international consensus statement. Nat Rev Endocrinol. 2018;14:476–500.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Pseudohypoparathyroidism - epidemiology, mortality and risk of complications. Clin Endocrinol (Oxf). 2016;84:904–11.

    Article  CAS  PubMed  Google Scholar 

  3. Nakamura Y, Matsumoto T, Tamakoshi A, Kawamura T, Seino Y, Kasuga M, Yanagawa H, Ohno Y. Prevalence of idiopathic hypoparathyroidism and pseudohypoparathyroidism in Japan. J Epidemiol. 2000;10:29–33.

    Article  CAS  PubMed  Google Scholar 

  4. Patten JL, Johns DR, Valle D, Eil C, Gruppuso PA, Steele G, Smallwood PM, Levine MA. Mutation in the gene encoding the stimulatory G protein of adenylate cyclase in Albright’s hereditary osteodystrophy. N Engl J Med. 1990;322:1412–9.

    Article  CAS  PubMed  Google Scholar 

  5. Linglart A, Levine MA, Juppner H. Pseudohypoparathyroidism. Endocrinol Metab Clin North Am. 2018;47:865–88.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Turan S. Current nomenclature of pseudohypoparathyroidism: inactivating parathyroid hormone/parathyroid hormone-related protein signaling disorder. J Clin Res Pediatr E. 2017;9:58–68.

    Google Scholar 

  7. de Nanclares GP, Fernandez-Rebollo E, Santin I, Garcia-Cuartero B, Gaztambide S, Menendez E, Morales MJ, Pombo M, Bilbao JR, Barros F, Zazo N, Ahrens W, Juppner H, Hiort O, Castano L, Bastepe M. Epigenetic defects of GNAS in patients with pseudohypoparathyroidism and mild features of Albright’s hereditary osteodystrophy. J Clin Endocrinol Metab. 2007;92:2370–3.

    Article  PubMed  Google Scholar 

  8. Turan S, Thiele S, Tafaj O, Brix B, Atay Z, Abali S, Haliloglu B, Bereket A, Bastepe M. Evidence of hormone resistance in a pseudo-pseudohypoparathyroidism patient with a novel paternal mutation in GNAS. Bone. 2015;71:53–7.

    Article  CAS  PubMed  Google Scholar 

  9. Silva BC, Bilezikian JP. Parathyroid hormone: anabolic and catabolic actions on the skeleton. Curr Opin Pharmacol. 2015;22:41–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Costa AG, Cremers S, Rubin MR, McMahon DJ, Sliney J Jr, Lazaretti-Castro M, Silverberg SJ, Bilezikian JP. Circulating sclerostin in disorders of parathyroid gland function. J Clin Endocrinol Metab. 2011;96:3804–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Ardawi MS, Al-Sibiany AM, Bakhsh TM, Rouzi AA, Qari MH. Decreased serum sclerostin levels in patients with primary hyperparathyroidism: a cross-sectional and a longitudinal study. Osteoporos Int. 2012;23:1789–97.

    Article  CAS  PubMed  Google Scholar 

  12. Lemaire V, Cox DR. Dynamics of bone cell interactions and differential responses to PTH and antibody-based therapies. Bull Math Biol. 2019;81:3575–622.

    Article  CAS  PubMed  Google Scholar 

  13. Potter LK, Greller LD, Cho CR, Nuttall ME, Stroup GB, Suva LJ, Tobin FL. Response to continuous and pulsatile PTH dosing: a mathematical model for parathyroid hormone receptor kinetics. Bone. 2005;37:159–69.

    Article  CAS  PubMed  Google Scholar 

  14. Onyia JE, Helvering LM, Gelbert L, Wei T, Huang S, Chen P, Dow ER, Maran A, Zhang M, Lotinun S, Lin X, Halladay DL, Miles RR, Kulkarni NH, Ambrose EM, Ma YL, Frolik CA, Sato M, Bryant HU, Turner RT. Molecular profile of catabolic versus anabolic treatment regimens of parathyroid hormone (PTH) in rat bone: an analysis by DNA microarray. J Cell Biochem. 2005;95:403–18.

    Article  CAS  PubMed  Google Scholar 

  15. Chen X, Meng Y, Tang M, Wang Y, Xie Y, Wan S, Tian H, Yu X (2020) A paternally inherited non-sense variant c.424G>T (p.G142*) in the first exon of XLalphas in an adult patient with hypophosphatemia and osteopetrosis. Clin Genet 97:712–722. This paper reported a patient carrying a novel non-sense variant c.424G>T (p. G142*) in the first exon of XLαs and presented with increased bone mass, hypophosphatemia, and elevated PTH levels. This paper indicated that SOST, DKK1, RANKL and OPG may be critically involved in abnormal bone metabolism in PHP subjects and GNAS locus should be considered as a candidate gene for high bone mass.

  16. Engstrom GW, Goff JP, Horst RL, Reinhardt TA. Regulation of calf renal 25-hydroxyvitamin D-hydroxylase activities by calcium-regulating hormones. J Dairy Sci. 1987;70:2266–71.

    Article  CAS  PubMed  Google Scholar 

  17. Unakami H, Furukawa Y, Sohn HE, Yumita S, Miura R, Hanew K, Yoshinaga K. Stimulation of 1,25-dihydroxyvitamin D production by parathyroid hormone and dibutyryl 3’,5’-cyclic AMP in normal subjects, hypoparathyroidism and pseudohypoparathyroidism. Tohoku J Exp Med. 1982;138:167–75.

    Article  CAS  PubMed  Google Scholar 

  18. Breslau NA, Moses AM, Pak CY. Evidence for bone remodeling but lack of calcium mobilization response to parathyroid hormone in pseudohypoparathyroidism. J Clin Endocrinol Metab. 1983;57:638–44.

    Article  CAS  PubMed  Google Scholar 

  19. Horiuchi N, Suda T, Takahashi H, Shimazawa E, Ogata E. In vivo evidence for the intermediary role of 3’,5’-cyclic AMP in parathyroid hormone-induced stimulation of 1alpha,25-dihydroxyvitamin D3 synthesis in rats. Endocrinology. 1977;101:969–74.

    Article  CAS  PubMed  Google Scholar 

  20. Mantovani G, Bondioni S, Locatelli M, Pedroni C, Lania AG, Ferrante E, Filopanti M, Beck-Peccoz P, Spada A. Biallelic expression of the Gsalpha gene in human bone and adipose tissue. J Clin Endocrinol Metab. 2004;89:6316–9.

    Article  CAS  PubMed  Google Scholar 

  21. Eubanks PJ, Stabile BE. Osteitis fibrosa cystica with renal parathyroid hormone resistance: a review of pseudohypoparathyroidism with insight into calcium homeostasis. Arch Surg. 1998;133:673–6.

    Article  CAS  PubMed  Google Scholar 

  22. Kruse K, Kracht U, Wohlfart K, Kruse U. Biochemical markers of bone turnover, intact serum parathyroid horn and renal calcium excretion in patients with pseudohypoparathyroidism and hypoparathyroidism before and during vitamin D treatment. Eur J Pediatr. 1989;148:535–9.

    Article  CAS  PubMed  Google Scholar 

  23. Long DN, Levine MA, Germain-Lee EL. Bone mineral density in pseudohypoparathyroidism type 1a. J Clin Endocrinol Metab. 2010;95:4465–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Underbjerg L, Malmstroem S, Sikjaer T, Rejnmark L. Bone status among patients with nonsurgical hypoparathyroidism, autosomal dominant hypocalcaemia, and pseudohypoparathyroidism: a cohort study. J Bone Miner Res. 2018;33:467–77.

    Article  CAS  PubMed  Google Scholar 

  25. Chu X, Zhu Y, Wang O, Nie M, Quan T, Xue Y, Wang W, Jiang Y, Li M, Xia W, Xing X. Bone mineral density and its serial changes are associated with PTH levels in pseudohypoparathyroidism type 1B patients. J Bone Miner Res. 2018;33:743–52.

    Article  CAS  PubMed  Google Scholar 

  26. Kanatani M, Sugimoto T, Kaji H, Ikeda K, Chihara K. Skeletal responsiveness to parathyroid hormone in pseudohypoparathyroidism. Eur J Endocrinol. 2001;144:263–9.

    Article  CAS  PubMed  Google Scholar 

  27. Burnstein MI, Kottamasu SR, Pettifor JM, Sochett E, Ellis BI, Frame B. Metabolic bone disease in pseudohypoparathyroidism: radiologic features. Radiology. 1985;155:351–6.

    Article  CAS  PubMed  Google Scholar 

  28. Frame B, Hanson CA, Frost HM, Block M, Arnstein AR. Renal resistance to parathyroid hormone with osteitis fibrosa: “pseudohypohyperparathyroidism.” Am J Med. 1972;52:311–21.

    Article  CAS  PubMed  Google Scholar 

  29. Tollin SR, Perlmutter S, Aloia JF. Serial changes in bone mineral density and bone turnover after correction of secondary hyperparathyroidism in a patient with pseudohypoparathyroidism type Ib. J Bone Miner Res. 2000;15:1412–6.

    Article  CAS  PubMed  Google Scholar 

  30. Neary NM, El-Maouche D, Hopkins R, Libutti SK, Moses AM, Weinstein LS. Development and treatment of tertiary hyperparathyroidism in patients with pseudohypoparathyroidism type 1B. J Clin Endocrinol Metab. 2012;97:3025–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kolb FO, Steinbach HL. Pseudohypoparathyroidism with secondary hyperparathyroidism and osteitis fibrosa. J Clin Endocrinol Metab. 1962;22:59–70.

    Article  CAS  PubMed  Google Scholar 

  32. Milgram JW, Engh CA, Hamilton CR Jr, Kammer GM. Renal resistance to parathyroid hormone with hyperphosphatemic osteomalacia and osteitis fibrosa. A case report. J Bone Joint Surg Am. 1974;56:1493–500.

    Article  CAS  PubMed  Google Scholar 

  33. Duck SC, Rosenberg EM, Ratzan SK, Haymond MW. Renal-resistant hormonoplethoric hypoparathyroidism with evidence for a defective response to cAMP. J Clin Endocrinol Metab. 1978;47:640–6.

    Article  CAS  PubMed  Google Scholar 

  34. Giraud P, Audran M, Rohmer V, Jallet P, Basle MF, Bregeon C, Bigorgne JC. Direct effect of calcitriol on the regulation of parathyroid hormone secretion in a case of pseudo-hypoparathyroidism (a 24-month follow-up study). Clin Rheumatol. 1995;14:287–91.

    Article  CAS  PubMed  Google Scholar 

  35. Murray TM, Rao LG, Wong MM, Waddell JP, McBroom R, Tam CS, Rosen F, Levine MA. Pseudohypoparathyroidism with osteitis fibrosa cystica: direct demonstration of skeletal responsiveness to parathyroid hormone in cells cultured from bone. J Bone Miner Res. 1993;8:83–91.

    Article  CAS  PubMed  Google Scholar 

  36. Sbrocchi AM, Rauch F, Lawson ML, Hadjiyannakis S, Lawrence S, Bastepe M, Juppner H, Ward LM. Osteosclerosis in two brothers with autosomal dominant pseudohypoparathyroidism type 1b: bone histomorphometric analysis. Eur J Endocrinol. 2011;164:295–301.

    Article  CAS  PubMed  Google Scholar 

  37. Dabbagh S, Chesney RW, Langer LO, DeLuca HF, Gilbert EF, DeWeerd JH Jr. Renal-nonresponsive, bone-responsive pseudohypoparathyroidism. A case with normal vitamin D metabolite levels and clinical features of rickets. Am J Dis Child. 1984;138:1030–3.

    Article  CAS  PubMed  Google Scholar 

  38. Cianferotti L, Biagini A, Fernández-Rebollo E, Jüppner H, Marcocci C. Sporadic pseudohypoparathyroidism with osteitis fibrosa cystica. Endocr Abstr. 2012;29:247.

    Google Scholar 

  39. Duan X, Yang Y, Wang O, Nie M, Chu X, Quan T, Guan W, Jiang Y, Li M, Xia W, Xing X (2021) Bone turnover markers are associated with the PTH levels in different subtypes of pseudohypoparathyroidism type 1 patients. Clin Endocrinol (Oxf) 95:277–285. This paper reported that the bone turnover markers of PHP1 patients were significantly higher than those of patients with nonsurgical hypoparathyroidism, and changes in bone turnover markers were associated with changes in PTH, indicating bone tissues respond partly to PTH in different PHP1 subtypes.

  40. Okazaki R. Parathyroid and bone. Bone metabolism in hypoparathyroidism. Clin Calcium. 2007;17:1852–7.

    CAS  PubMed  Google Scholar 

  41. Hanna P, Grybek V, Perez de Nanclares G, Tran LC, de Sanctis L, Elli F, Errea J, Francou B, Kamenicky P, Linglart L, Pereda A, Rothenbuhler A, Tessaris D, Thiele S, Usardi A, Shoemaker AH, Kottler ML, Juppner H, Mantovani G, Linglart A. Genetic and epigenetic defects at the GNAS locus lead to distinct patterns of skeletal growth but similar early-onset obesity. J Bone Miner Res. 2018;33:1480–8.

    Article  CAS  PubMed  Google Scholar 

  42. Wang Y, Tian H, Chen X. The distinct role of the extra-large G protein a-subunit XLas. Calcif Tissue Int. 2020;107:212–9.

    Article  CAS  PubMed  Google Scholar 

  43. Elli FM, Mantovani G. Pseudohypoparathyroidism, acrodysostosis, progressive osseous heteroplasia: different names for the same spectrum of diseases? Endocrine. 2021;72:611–8.

    Article  CAS  PubMed  Google Scholar 

  44. Mantovani G, Bastepe M, Monk D, de Sanctis L, Thiele S, Ahmed SF, Bufo R, Choplin T, De Filippo G, Devernois G, Eggermann T, Elli FM, Garcia Ramirez A, Germain-Lee EL, Groussin L, Hamdy NAT, Hanna P, Hiort O, Juppner H, Kamenicky P, Knight N, Le Norcy E, Lecumberri B, Levine MA, Makitie O, Martin R, Martos-Moreno GA, Minagawa M, Murray P, Pereda A, Pignolo R, Rejnmark L, Rodado R, Rothenbuhler A, Saraff V, Shoemaker AH, Shore EM, Silve C, Turan S, Woods P, Zillikens MC, Perez de Nanclares G, Linglart A. Recommendations for diagnosis and treatment of pseudohypoparathyroidism and related disorders: an updated practical tool for physicians and patients. Horm Res Paediatr. 2020;93:182–96.

    Article  CAS  PubMed  Google Scholar 

  45. Huh JY, Kwon MJ, Seo KY, Kim MK, Chae KY, Kim SH, Ki CS, Yoon MS, Kim DH. Novel nonsense GNAS mutation in a 14-month-old boy with plate-like osteoma cutis and medulloblastoma. J Dermatol. 2014;41:319–21.

    Article  PubMed  Google Scholar 

  46. Tresserra L, Tresserra F, Grases PJ, Badosa J, Tresserra M. Congenital plate-like osteoma cutis of the forehead: an atypical presentation form. J Craniomaxillofac Surg. 1998;26:102–6.

    Article  CAS  PubMed  Google Scholar 

  47. Wilson JD, Hadden DR. Pseudohypoparathyroidism presenting with rickets. J Clin Endocrinol Metab. 1980;51:1184–9.

    Article  CAS  PubMed  Google Scholar 

  48. Bajpai A, Sharma J, Hari P, Bagga A. Pseudohypoparathyroidism presenting with bony deformities resembling rickets. Indian J Pediatr. 2004;71:345–8.

    Article  PubMed  Google Scholar 

  49. Decker E, Stellzig-Eisenhauer A, Fiebig BS, Rau C, Kress W, Saar K, Ruschendorf F, Hubner N, Grimm T, Weber BH. PTHR1 loss-of-function mutations in familial, nonsyndromic primary failure of tooth eruption. Am J Hum Genet. 2008;83:781–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Yamaguchi T, Hosomichi K, Narita A, Shirota T, Tomoyasu Y, Maki K, Inoue I. Exome resequencing combined with linkage analysis identifies novel PTH1R variants in primary failure of tooth eruption in Japanese. J Bone Miner Res. 2011;26:1655–61.

    Article  CAS  PubMed  Google Scholar 

  51. Reis MT, Matias DT, Faria ME, Martin RM. Failure of tooth eruption and brachydactyly in pseudohypoparathyroidism are not related to plasma parathyroid hormone-related protein levels. Bone. 2016;85:138–41.

    Article  CAS  PubMed  Google Scholar 

  52. Vahle JL, Sato M, Long GG, Young JK, Francis PC, Engelhardt JA, Westmore MS, Linda Y, Nold JB. Skeletal changes in rats given daily subcutaneous injections of recombinant human parathyroid hormone (1–34) for 2 years and relevance to human safety. Toxicol Pathol. 2002;30:312–21.

    Article  CAS  PubMed  Google Scholar 

  53. Jimenez C, Yang Y, Kim HW, Al-Sagier F, Berry DA, El-Naggar AK, Patel S, Vassilopoulou-Sellin R, Gagel RF. Primary hyperparathyroidism and osteosarcoma: examination of a large cohort identifies three cases of fibroblastic osteosarcoma. J Bone Miner Res. 2005;20:1562–8.

    Article  PubMed  Google Scholar 

  54. Park HS, Kim CG, Hong N, Lee SJ, Seo DH, Rhee Y. Osteosarcoma in a patient with pseudohypoparathyroidism type 1b due to paternal uniparental disomy of chromosome 20q. J Bone Miner Res. 2017;32:770–5.

    Article  CAS  PubMed  Google Scholar 

  55. Breslau NA, Notman DD, Canterbury JM, Moses AM. Studies on the attainment of normocalcemia in patients with pseudohypoparathyroidism. Am J Med. 1980;68:856–60.

    Article  CAS  PubMed  Google Scholar 

  56. Gertner JM, Tomlinson S, Gonzalez-Macias J. Normocalcaemic pseudohypoparathyroidism with unusual phenotype. Arch Dis Child. 1978;53:312–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Levine MA. Pseudohypoparathyroidism: from bedside to bench and back. J Bone Miner Res. 1999;14:1255–60.

    Article  CAS  PubMed  Google Scholar 

  58. Shalitin S, Davidovits M, Lazar L, Weintrob N. Clinical heterogeneity of pseudohypoparathyroidism: from hyper- to hypocalcemia. Horm Res. 2008;70:137–44.

    CAS  PubMed  Google Scholar 

  59. Seo D, Rhee Y. Osteitis fibrosa cystica in primary hyperparathyroidism. QJM. 2015;108:991.

    Article  CAS  PubMed  Google Scholar 

  60. Srivastava T, Krudys J, Mardis NJ, Sebestyen-VanSickle J, Alon US. Cinacalcet as adjunctive therapy in pseudohypoparathyroidism type 1b. Pediatr Nephrol. 2016;31:795–800.

    Article  PubMed  Google Scholar 

  61. Sharma M, Nolkha N, Sharma A, Bhadu D, Dhakad U, Singh R, Das SK. Spondyloarthropathy-like findings and diffuse osteosclerosis as the presenting feature of pseudohypoparathyroidism. Jcr-J Clin Rheumatol. 2016;22:102–4.

    Article  Google Scholar 

  62. Kolb FO, Steinbach HL. Pseudohypoparathyroidism with secondary hyperparathyroidism and osteitis fibrosa. J Clin Endocr Metab. 1962;22:59–70.

    Article  CAS  PubMed  Google Scholar 

  63. Frame B, Block M, Arnstein AR, Hanson CA, Frost HM. Renal resistance to parathyroid-hormone with osteitis fibrosa pseudohypohyperparathyroidism. Am J Med. 1972;52:311–21.

    Article  CAS  PubMed  Google Scholar 

  64. Giraud P, Audran M, Rohmer V, Jallet P, Basle MF, Bregeon C, Bigorgne JC. Direct effect of calcitriol on the regulation of parathyroid-hormone secretion in a case of pseudo-hypoparathyroidism (a 24-Month Follow-up-Study). Clin Rheumatol. 1995;14:287–91.

    Article  CAS  PubMed  Google Scholar 

  65. Neary NM, El-Maouche D, Hopkins R, Libutti SK, Moses AM, Weinstein LS. Development and treatment of tertiary hyperparathyroidism in patients with pseudohypoparathyroidism Type 1B. J Clin Endocr Metab. 2012;97:3025–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Itoh M, Okajima M, Kittaka Y, Yachie A, Wada T, Saikawa Y. Tertiary hyperparathyroidism in patients with pseudohypoparathyroidism type 1a. Bone Rep. 2022;16:101569.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank Angela Morben, DVM, ELS, from Liwen Bianji (Edanz) (www.liwenbianji.cn), for editing the English text of a draft of this manuscript.

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  1. Department of Endocrinology, Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China

    Yan Wang, Chunyan Lu & Xiang Chen

  2. Department of Geriatric Medicine, the People’s Hospital of Deyang City, Deyang, 618000, China

    Yan Wang

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Wang, Y., Lu, C. & Chen, X. Variable Bone Phenotypes in Patients with Pseudohypoparathyroidism. Curr Osteoporos Rep 21, 311–321 (2023). https://doi.org/10.1007/s11914-023-00787-6

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