From the Guidelines
Low alkaline phosphatase (ALP) levels in the blood can indicate several underlying conditions that require medical attention, and the primary cause should be identified and addressed to improve morbidity, mortality, and quality of life. If you have low ALP, you should consult with a healthcare provider for proper evaluation. Potential causes include:
- Malnutrition
- Protein deficiency
- Zinc deficiency
- Vitamin C deficiency
- Wilson's disease
- Rare genetic conditions like hypophosphatasia No specific medication directly treats low ALP, as treatment focuses on addressing the underlying cause. For nutritional deficiencies, supplementation may be recommended - zinc supplements (15-30 mg daily), vitamin C (500-1000 mg daily), or protein intake increase might be appropriate depending on the specific deficiency 1. Your doctor will likely order additional tests to determine the exact cause, including zinc levels, liver function tests, and possibly genetic testing if hypophosphatasia is suspected. Low ALP itself is not typically dangerous, but it serves as an important marker that something may be imbalanced in your body. ALP is an enzyme produced primarily in the liver and bones that helps break down proteins, so abnormal levels can reflect problems with these organ systems or nutritional status. In some cases, low ALP levels can be associated with Wilson's disease, a rare genetic disorder that affects copper metabolism, and a high bilirubin to alkaline phosphatase ratio can be a reliable indicator of this condition 1. It is essential to identify and address the underlying cause of low ALP levels to prevent long-term complications and improve overall health outcomes.
From the Research
Causes of Low Alkaline Phosphatase (ALP) Levels
- Low serum ALP levels can be caused by various factors, including:
- Genetic disorders, such as hypophosphatasia, which is caused by mutations in the ALPL gene 2, 3, 4
- Acquired disorders, such as malnutrition, vitamin and mineral deficiencies, and endocrine disorders 2
- Drug therapy, including antiresorptives 2, 3, 4
- Chronic liver diseases, which can lead to low ALP levels in some patients 5
- Hypophosphatasia is a rare metabolic bone disorder characterized by low circulating ALP levels and bone, muscle, dental, and systemic manifestations 3, 4
- Low ALP levels can also be associated with less biochemical evidence of active disease in patients with chronic liver diseases 5
- Mutations in the ALPL gene can be found in individuals with low ALP levels, and these mutations can be associated with tooth loss, lower levels of serum ALP, and higher levels of pyridoxal phosphate and urine phosphoethanolamine 6
Clinical Significance of Low ALP Levels
- Low ALP levels can be a screening tool for hypophosphatasia, a condition that may be misdiagnosed as osteoporosis 3
- Persistently low ALP levels can signal the possibility of hypophosphatasia, and patients with this condition may be at risk of being misdiagnosed and incorrectly treated with antiresorptive therapy 3, 4
- Low ALP levels can also be associated with mild musculoskeletal pain and other minor complaints, but major health problems are rare in individuals with low ALP levels 6
Biochemical and Genetic Spectrum of Low ALP Levels
- ALP levels can be inversely correlated with serum calcium, pyridoxal phosphate, and urine phosphoethanolamine 6
- Mutations in the ALPL gene can be found in individuals with low ALP levels, and these mutations can be associated with substrate accumulation and defects in calcified tissues 6
- The presence of a mutated allele can be associated with tooth loss, lower levels of serum ALP, and higher levels of pyridoxal phosphate and urine phosphoethanolamine 6