From the Guidelines
Treatment for low alkaline phosphatase levels should focus on addressing the underlying cause, and in cases of X-linked hypophosphataemia (XLH), symptomatic adults may be treated with active vitamin D and oral phosphorus to reduce osteomalacia and its consequences, as recommended by the most recent guidelines 1. The primary approach involves identifying and treating conditions such as hypophosphatasia, malnutrition, zinc deficiency, or vitamin B6 deficiency that may be causing low ALP.
- For nutritional deficiencies, supplementation is recommended:
- zinc supplements (15-30 mg daily for adults)
- vitamin B6 (50-100 mg daily)
- magnesium (300-400 mg daily)
- ensuring adequate vitamin D intake (1000-2000 IU daily)
- Improving overall nutrition with a balanced diet rich in proteins, vitamins, and minerals is essential.
- For hypophosphatasia, enzyme replacement therapy with asfotase alfa (Strensiq) may be prescribed, typically administered as subcutaneous injections multiple times per week, with dosing based on patient weight and disease severity, as per the guidelines for XLH management 1. It's also important to note that mildly low ALP levels without symptoms may not require treatment, and treatment plans should be individualized, considering the patient's specific condition, age, and symptoms, with a focus on improving morbidity, mortality, and quality of life 1. Regular monitoring of ALP levels and other relevant markers is necessary to assess treatment effectiveness. Patients should consult healthcare providers for personalized treatment plans, as low ALP can sometimes indicate serious underlying conditions requiring specific medical intervention. In the context of XLH, the recommended dose range for phosphate supplements is 750–1,600mg daily (based on elemental phosphorus), and for calcitriol and alfacalcidol, the doses are 0.50–0.75 and 0.75–1.5μg daily, respectively 1.
From the FDA Drug Label
STRENSIQ is a tissue nonspecific alkaline phosphatase indicated for the treatment of patients with perinatal/infantile- and juvenile-onset hypophosphatasia (HPP). (1)
The treatment for low alkaline phosphatase levels is asfotase alfa (STRENSIQ), a tissue nonspecific alkaline phosphatase.
- The recommended dosage regimen for perinatal/infantile-onset HPP is 2 mg/kg administered subcutaneously three times per week, or 1 mg/kg administered six times per week 2.
- The recommended dosage regimen for juvenile-onset HPP is also 2 mg/kg administered subcutaneously three times per week, or 1 mg/kg administered six times per week 2.
From the Research
Treatment for Low Alkaline Phosphatase Levels
The treatment for low alkaline phosphatase levels, particularly in the context of hypophosphatasia, involves a multidisciplinary approach. Some key aspects of treatment include:
- Enzyme replacement therapy with asfotase alfa, which has been shown to improve bone health, mobility, growth, and breathing ability, and relieve pain 3, 4, 5, 6
- Nutritional support, including adjustment of calcium and phosphate intake 3
- Monitoring of vitamin D levels 3
- Careful and personalized physical therapy 3
- Regular dental monitoring and care, as dental problems are common in hypophosphatasia 3, 4
Enzyme Replacement Therapy
Asfotase alfa is a bone-targeted human TNAP enzyme replacement therapy that has been approved for the long-term treatment of bone manifestations in pediatric-onset hypophosphatasia 6. Studies have shown that asfotase alfa improves physical function, non-skeletal symptoms such as pain, and quality of life in adults with hypophosphatasia, regardless of age of onset 4, 5.
Importance of Early Diagnosis
Early diagnosis of hypophosphatasia is crucial, and low alkaline phosphatase levels can be a key indicator of the disease 7. Laboratories should consider flagging low alkaline phosphatase levels as abnormal to prompt physicians to investigate for undiagnosed hypophosphatasia 7.
Alternative Treatments
Alternatives to asfotase alfa are limited, but a derivative, efzimfotase alfa, is currently undergoing clinical testing 4.