From the Guidelines
Elevated Alkaline Phosphatase (ALP) levels are primarily caused by liver diseases, such as cholestatic liver disease, cirrhosis, and hepatitis, as well as bone disorders like Paget's disease and osteomalacia, as stated in the most recent study 1. The main causes of elevated ALP levels can be categorized into:
- Liver diseases:
- Cholestatic liver disease, such as primary biliary cholangitis and primary sclerosing cholangitis
- Cirrhosis
- Hepatitis (viral, alcoholic, or autoimmune)
- Biliary obstruction (e.g., gallstones, tumors)
- Bone disorders:
- Paget's disease
- Osteomalacia
- Bone metastases
- Fractures
- Other causes:
- Pregnancy (due to placental production) 1
- Certain medications (e.g., anticonvulsants, antibiotics)
- Intestinal diseases (e.g., inflammatory bowel disease)
- Some cancers (e.g., lymphoma, leukemia) To determine the specific cause of elevated ALP levels, additional tests such as liver function tests, bone scans, or imaging studies may be necessary, as suggested by the study 1. It's essential to note that concomitantly elevated gamma-glutamyl transpeptidase (GGT) can help confirm that an elevated ALP originates from the liver and indicates cholestasis, as stated in the study 1. In clinical practice, it is crucial to consider the patient's clinical history, medications, and laboratory results to determine the underlying cause of elevated ALP levels and provide appropriate treatment, as implied by the study 1.
From the Research
Causes of Elevated Alkaline Phosphatase (ALP)
Elevated Alkaline Phosphatase (ALP) levels can be caused by various factors, including:
- Underlying malignancy, such as infiltrative intrahepatic malignancy, bony metastasis, or both hepatic and bone metastasis 2
- Bone disease, including Paget's disease 3
- Unsuspected parenchymal liver disease, such as liver hemangiomas, sarcoid hepatitis, or drug-induced cholestasis 2, 3
- Non-malignant infiltrative liver disease, such as mycobacterium avium intracellulare (MAI) infection or cytomegalovirus infection 3
- Sepsis, including gram-negative or gram-positive organisms, or fungal sepsis 3
- Biliary obstruction, including malignant obstruction or common bile duct stone 3
- Acquired immunodeficiency syndrome (AIDS) 3
- Renal damage, including malignancy, complicated nephrolithiasis, or surgical and percutaneous manipulations 4
- Liver disease, including alcohol-induced hepatitis, which can lead to elevated ALP levels in patients with hypophosphatasia 5
- Benign intrahepatic disease, including liver hemangiomas or sarcoid hepatitis 3
- Other disorders, such as lead toxicity or drug-induced cholestasis 3