From the Guidelines
An elevated alkaline phosphatase (ALP) level of 207 indicates potential liver or bone disease that requires further investigation. Normal ALP ranges typically between 40-130 U/L for adults, though reference ranges vary by laboratory and patient factors like age and gender 1. This elevation could suggest conditions such as liver disorders (hepatitis, cirrhosis, bile duct obstruction), bone disorders (Paget's disease, osteomalacia, bone metastases), or other causes including pregnancy, certain medications, or healing fractures.
Possible Causes
- Liver disorders: hepatitis, cirrhosis, bile duct obstruction
- Bone disorders: Paget's disease, osteomalacia, bone metastases
- Other causes: pregnancy, certain medications, or healing fractures The elevation is moderate and not immediately alarming, but should not be ignored. Additional testing is necessary to determine the specific cause, including gamma-glutamyl transferase (GGT) to differentiate between liver and bone sources, liver function tests, and possibly imaging studies 1. The patient should consult their healthcare provider promptly for proper evaluation, as the clinical context and patient's symptoms are crucial for accurate interpretation of this laboratory finding.
Next Steps
- Consult healthcare provider for proper evaluation
- Additional testing: GGT, liver function tests, imaging studies
- Clinical context and patient's symptoms are crucial for accurate interpretation
From the Research
Alkaline Phosphatase Level of 207
- An elevated alkaline phosphatase (ALP) level of 207 can indicate various conditions, including underlying malignancy, bone disease, unsuspected parenchymal liver disease, non-malignant infiltrative liver disease, and other disorders 2.
- The most common cause of ALP elevation is due to underlying malignancy, with 57% of patients having infiltrative intrahepatic malignancy, bony metastasis, or both hepatic and bone metastasis 2.
- Bone disease accounts for 29% of ALP elevations, while unsuspected parenchymal liver disease and non-malignant infiltrative liver disease account for 7% and 2%, respectively 2.
- Other disorders, such as sepsis, malignant obstruction, and AIDS, can also cause extremely high elevations of ALP 3.
- In patients with chronic kidney disease (CKD), elevated ALP levels can be associated with kidney bone disease, mortality, and cardiovascular disease 4, 5.
- Defective elimination of ALP can also play a role in unexplained elevations of serum ALP 6.
Possible Causes
- Underlying malignancy
- Bone disease
- Unsuspected parenchymal liver disease
- Non-malignant infiltrative liver disease
- Sepsis
- Malignant obstruction
- AIDS
- Kidney bone disease
- Cardiovascular disease
Clinical Significance
- An isolated, elevated ALP of unclear etiology is associated with several specific and important disorders, including metastatic intrahepatic malignancy 2.
- Providers should be aware of the potential clinical significance of an elevated ALP, as it can indicate a serious underlying condition 2.
- Further evaluation and testing may be necessary to determine the cause of an elevated ALP level 2, 3, 6.