Jetter EM, Lucke-Wold BP. When the diagnosis misses the mark: The psychiatric cost of misdiagnosing hypophosphatasia as fibromyalgia. World J Clin Cases 2025; 13(31): 109020 [DOI: 10.12998/wjcc.v13.i31.109020]
Corresponding Author of This Article
Ethan M Jetter, Doctorate Student, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32601, United States. ejetter@ufl.edu
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Psychiatry
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Editorial
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 6, 2025 (publication date) through Nov 8, 2025
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Publication Name
World Journal of Clinical Cases
ISSN
2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Jetter EM, Lucke-Wold BP. When the diagnosis misses the mark: The psychiatric cost of misdiagnosing hypophosphatasia as fibromyalgia. World J Clin Cases 2025; 13(31): 109020 [DOI: 10.12998/wjcc.v13.i31.109020]
When the diagnosis misses the mark: The psychiatric cost of misdiagnosing hypophosphatasia as fibromyalgia
Ethan M Jetter, Brandon P Lucke-Wold
Ethan M Jetter, College of Medicine, University of Florida, Gainesville, FL 32601, United States
Brandon P Lucke-Wold, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, United States
Author contributions: Jetter EM conceptualized the editorial topic, conducted the literature review, and contributed to drafting the manuscript; Lucke-Wold BP contributed to drafting, critically revising, and refining the manuscript for important intellectual content; and all authors reviewed and approved the final version and take responsibility for the content.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ethan M Jetter, Doctorate Student, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32601, United States. ejetter@ufl.edu
Received: April 28, 2025 Revised: June 27, 2025 Accepted: September 1, 2025 Published online: November 6, 2025 Processing time: 185 Days and 15.7 Hours
Abstract
Hypophosphatasia (HPP) is a rare metabolic bone disorder often misdiagnosed as fibromyalgia due to overlapping symptoms such as chronic pain, fatigue, and muscle weakness. This diagnostic error disproportionately affects women and can result in significant psychological distress due to repeated dismissal of symptoms. Despite low serum alkaline phosphatase (ALP) being a key biochemical clue to HPP, it is frequently overlooked in standard diagnostic evaluations. Consequently, many patients endure years of ineffective treatment, invalidation, and worsening psychiatric outcomes. This editorial emphasizes the need for greater clinical vigilance in distinguishing HPP from fibromyalgia, particularly when features such as chronic pain, premature tooth loss, and persistently low ALP are present. Gender biases in pain diagnosis further compound this problem, leading to greater misdiagnosis rates among women and contributing to the erosion of trust in medical care. The psychiatric consequences of diagnostic delays are substantial, with affected individuals experiencing elevated rates of depression, anxiety, and emotional distress. Greater recognition of low ALP as a meaningful diagnostic clue may enhance diagnostic accuracy, improve patient outcomes, and reduce the psychological toll of misdiagnosis.
Core Tip: Hypophosphatasia is a rare metabolic bone disease that is susceptible to misdiagnosis as fibromyalgia due to overlapping symptoms such as chronic pain, fatigue, and weakness. This editorial highlights how overlooked low alkaline phosphatase levels and gender bias in pain assessment contribute to diagnostic delays. Greater recognition of hypophosphatasia may help reduce psychiatric harm associated with misdiagnosis.
