From the Guidelines
The alkaline phosphatase (ALP) level of 116 in a 72-year-old female is likely within or slightly above the normal range, and thus, no immediate intervention is required. This finding is based on the understanding that normal ALP ranges for adults typically fall between 40-130 IU/L, though reference ranges can vary between laboratories 1. A mildly elevated ALP may be related to normal aging, as ALP levels tend to increase in older adults, particularly in postmenopausal women due to increased bone turnover.
Key Considerations
- The patient's age and the fact that ALP levels can be higher in older adults, especially postmenopausal women, should be taken into account when interpreting the ALP level 1.
- ALP is produced by several organs, including the liver, bones, intestines, and placenta, so persistent elevation might indicate conditions affecting these organs such as Paget's disease, osteomalacia, biliary obstruction, or certain medications.
- If this is an isolated finding without symptoms or other abnormal liver tests, routine monitoring at the next regular check-up is reasonable.
- However, if the patient has symptoms like bone pain, unexplained weight loss, fatigue, or jaundice, further evaluation would be warranted to determine the cause of the elevated ALP.
Next Steps
- Review of the patient’s clinical history and medications to assess for any potential causes of elevated ALP.
- Consider measurements of GGT to indicate whether pathologically elevated ALP is of hepatic or nonhepatic origin, as suggested by the study 1.
- Imaging of the biliary tree may be necessary if the liver is suspected to be the source of elevated ALP and to determine the etiology of extrahepatic or intrahepatic cholestasis.
From the Research
Alkaline Phosphatase (ALP) Levels
- An ALP level of 116 in a 72-year-old female may indicate an underlying condition that requires further investigation, as suggested by 2.
- Elevated ALP levels can be caused by various factors, including bone disease, liver disease, and malignancy, as reported in 2.
Possible Causes of Elevated ALP
- Underlying malignancy is a common cause of elevated ALP levels, accounting for 57% of cases in one study 2.
- Bone disease is another possible cause, accounting for 29% of cases in the same study 2.
- Other causes of elevated ALP levels include unsuspected parenchymal liver disease, non-malignant infiltrative liver disease, and other disorders 2.
Clinical Significance of Elevated ALP
- An isolated, elevated ALP level of unclear etiology is associated with several important disorders, including metastatic intrahepatic malignancy 2.
- Providers should be aware of the potential clinical significance of an elevated ALP level and investigate further to determine the underlying cause, as recommended by 2.
- Bone alkaline phosphatase (BALP) is an important biomarker in chronic kidney disease - mineral and bone disorder, and may be useful in diagnosing and monitoring bone turnover in this condition 3.