From the Guidelines
Elevated alkaline phosphatase (ALP) with normal gamma-glutamyl transferase (GGT) typically suggests a non-liver source of the ALP elevation, most likely pointing to bone disorders as the cause, such as Paget's disease, osteomalacia, or bone metastases, as indicated by the most recent study 1.
Key Considerations
- The elevation of ALP can occur in various conditions, including bone disease, liver disease, and other disorders, as noted in 1.
- The normal GGT level helps to rule out hepatobiliary causes, as liver disease typically elevates both ALP and GGT, according to 1 and 1.
- Bone-specific ALP isoenzyme testing can help identify the source of elevated ALP, as mentioned in 1.
- Additional testing, such as vitamin D levels or bone scans, may be necessary to determine the underlying cause of elevated ALP, as suggested by 1 and 1.
Diagnostic Approach
- A thorough medical history and physical examination are essential in determining the cause of elevated ALP, as emphasized in 1 and 1.
- Imaging studies, such as bone scans or radiographs, may be necessary to evaluate bone health and detect potential abnormalities, as noted in 1 and 1.
- Laboratory tests, including ALP isoenzyme testing and vitamin D levels, can help confirm the diagnosis and guide treatment, according to 1 and 1.
Treatment
- Treatment of elevated ALP due to bone disorders depends on the underlying condition, such as vitamin D supplementation for osteomalacia or bisphosphonates for Paget's disease, as mentioned in 1 and 1.
- Management of underlying conditions, such as bone disease or liver disease, is crucial to prevent long-term complications and improve quality of life, as emphasized in 1, 1, 1, and 1.
From the Research
Elevated Alkaline Phosphatase with Normal GGT
Elevated alkaline phosphatase (ALP) with normal gamma-glutamyl transferase (GGT) can be indicative of bone-related disorders.
- The measurement of bone-specific proteins, such as bone alkaline phosphatase (BAP), can be useful in assessing skeletal status 2.
- Paget's disease of bone (PDB) is a common destructive condition of bone that can cause elevated ALP levels, and is usually asymptomatic 3.
- In patients with liver disease, BAP levels are normal, whereas total ALP is elevated, suggesting that BAP can be a more specific marker for bone disease 2.
Possible Causes
Possible causes of elevated ALP with normal GGT include:
- Paget's disease of bone (PDB) 3, 4, 5, 6
- Other bone disorders, such as osteomalacia 4
- Bone metastases or other bone diseases 6
Diagnostic Markers
Diagnostic markers that can be used to assess bone turnover and disease activity include: