From the Guidelines
Raised alkaline phosphatase (ALP) levels indicate potential liver or bone disorders that require medical evaluation, and the most recent evidence suggests that concomitantly elevated GGT can help confirm that an elevated ALP originates from the liver and indicates cholestasis 1.
Causes of Elevated ALP
The causes of elevated ALP can be broadly categorized into liver and bone disorders. Liver diseases such as hepatitis, cirrhosis, bile duct obstruction, and cholestasis can cause elevated ALP levels. Bone disorders like Paget's disease, bone metastases, and fracture healing can also lead to elevated ALP. Other causes include pregnancy, certain medications, and some cancers.
Diagnostic Approach
If you have elevated ALP, it is essential to consult your healthcare provider for proper diagnosis through additional tests like GGT, ALT, AST, and bilirubin to determine if the source is hepatic or bone-related 1. Imaging studies such as ultrasound, CT scan, or bone scan may be necessary to confirm the diagnosis. For example, magnetic resonance cholangiopancreaticography (MRCP) is recommended for diagnosing large duct primary sclerosing cholangitis (PSC) 1.
Treatment and Management
Treatment depends entirely on the underlying cause - addressing liver disease, managing bone disorders, adjusting medications, or treating cancer as appropriate. The significance of raised ALP varies widely based on how elevated the levels are and what's causing them, so professional medical assessment is essential rather than self-diagnosis or treatment.
Key Points to Consider
- Elevated ALP levels can indicate liver or bone disorders
- Concomitantly elevated GGT can help confirm hepatic origin of elevated ALP
- Diagnostic approach includes additional tests and imaging studies
- Treatment depends on the underlying cause
- Professional medical assessment is essential for proper diagnosis and management 1
From the Research
Raised Alkaline Phosphatase
- Raised alkaline phosphatase (ALP) values are indicative of a number of diseases, most commonly affecting the skeleton and the biliary tract 2
- The measurement of total ALP activity in serum or in plasma is a useful biomarker in clinical practice, and routine measurement of serum total ALP is a long-standing established part of initial biochemical evaluation of patients 2
- Electrophoretic assays are preferable for visualizing and investigating the cause of increased serum total ALP activities 2
- Bone ALP immunoassays are preferable for investigating and monitoring individuals with bone and mineral metabolic abnormalities 2
Diagnostic Approach
- A holistic vision of ALP is suggested, including a clinical approach to the identification of diseases causing abnormal values 2
- The diagnostic approach involves searching for articles on PubMed for terms such as alkaline phosphatases, isozymes, isoforms, bone alkaline phosphatase, liver alkaline phosphatase, intestinal alkaline phosphatase, placental alkaline phosphatase, liver function tests, γ-glutamyltransferase, skeletal diseases, and liver diseases 2