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First episode was the spontaneous fracture of two metatarsals of his left foot (Fig. 1) while standing. Physical exam was significant for multiple repaired dental caries, left foot wearing an ortho boot, and normal height, head, eyes, ears, nose, and throat, heart, lung, abdominal examinations. Bone biopsy may show nonmineralized bone matrix. Since our patient had elevated urine PEA and a heterozygous ALPL gene mutation, bone biopsy was not performed.