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Elevated Alkaline Phosphatase

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Definition

The elevated alkaline phosphatase is a modification in the levels of alkaline phosphatase, which is a hydrolase enzyme responsible for the removal of phosphate from the different molecules of the body. Despite extensive research, scientists have not yet been able to identify the exact reasons that contribute to an increase in the alkaline phosphatase levels. The elevated alkaline phosphatase levels are of clinical importance, as they are often in association with different medical conditions.


Normal levels of alkaline phosphatase

Alkaline phosphatase can be found in higher (normal) concentrations in the following parts of the body: liver, bile, duct, kidney, bone, intestinal mucosa and placenta. In healthy adults, the normal levels of alkaline phosphatase vary between 20 and 140 IU/L. It is important to note that the levels are increased in women who are pregnant and in children.

Causes

There are the main causes that cause the alkaline phosphatase levels to become elevated:

  • Obstruction of the biliary duct
  • Active bone formation – alkaline phosphatase results from the activity of the osteoblasts (such changes are encountered in patients who are diagnosed with Paget’s disease of the bone – chronic disorder, in which the bones become enlarged and take abnormal shapes)
  • Celiac disease – the levels of alkaline phosphatase are increased in those who do not get/receive treatment for this condition
  • Seminoma – elevated levels of placental alkaline phosphatase; this is a medical condition in which a tumor appears at the level of the testicle or in the mediastinum (malignant neoplasm, high survival rate if identified in time)
  • Rickets – elevated levels of placental alkaline phosphatase; this is a medical condition in which the bones mineralize or calcify before the epiphyses close (impaired vitamin D, phosphorus or calcium metabolism)
  • Other bone diseases
    • Osteoblastic tumor of the bone
    • Osteomalacia – medical condition in which the bones soften, due to the bone mineralization (insufficient quantities of phosphate and calcium or because of hypercalcemia)
    • Osteosarcoma – aggressive malignant neoplasm affecting different bones of the body
    • Bone metastases – prostate cancer (significantly high levels of alkaline phosphatase); other types of cancer
    • Renal osteodystrophy – medical condition in which there is a deficiency in the mineralization of the bone, being often found in association with chronic kidney disease
    • Bone fracture – open or closed
    • Multiple myeloma (in association with bone fractures) – type of cancer that affects the plasma cells, with clusters of abnormal cells appearing at the level of the bone marrow
    • Vitamin D deficiency (moderately high levels of alkaline phosphatase)
    • Other malignant tumors of the bone
    • Skeletal involvement in the renal disease (appears as a complication of hyperparathyroidism)
  • Disease of the liver
    • Hepatitis – inflammation of the liver, caused by different hepatic viruses (A, B, C, D and E)
    • Primary biliary cirrhosis – autoimmune disease of the liver
    • Cholestasis – medical condition in which the flow of the bile is obstructed from the liver to the duodenum
    • Cholecystitis – inflammation of the gallbladder
    • Fatty liver
    • Tumors of the liver
    • Liver metastases
    • Intoxication of the liver with drugs
  • Different types of cancer
    • Leukemia – cancer of the bone marrow
    • Lymphoma – tumors of the blood cells (developed from the lymphatic system)
    • Breast cancer
    • Colon cancer
    • Hodgkin lymphoma – cancer of the white blood cells
    • Lung cancer
    • Pancreatic cancer
  • Inflammatory conditions
    • Sarcoidosis – medical condition in which inflammatory cells gather in clusters (granulomas) and form nodules in different organs of the body
  • Thyroid and parathyroid disorders
    • Hyperthyroidism
    • Hyperparathyroidism
  • Pregnancy
  • Medication
    • Verapamil
    • Carbamazepine
    • Phenytoin
    • Erythromycin
    • Allopurinol
    • Ranitidine
    • Chlorpropamide

Other causes

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  • Infectious mononucleosis
  • Primary sclerosing cholangitis
  • Polycythemia vera – neoplasm characterized by the excessive production of red blood cells in the bone marrow
  • Myelofibrosis – rare bone marrow cancer
  • Leukemoid reaction (to infection) – increased levels of white blood cells
  • Contraceptive usage
  • Herpes zoster (shingles)
  • Amyloidosis – accumulation of amyloids, which are proteins that are inappropriately folded
  • Granulation tissue – appears at the site of a wound, as a result of the healing process
  • Gastrointestinal inflammation
    • Inflammatory bowel disease
    • Ulcerative colitis
    • Crohn’s disease
    • Ulcer
  • Rheumatoid arthritis
  • Transient hyperphosphatasemia
    • Appears in infants
    • Benign condition
    • Often found in association with an infectious process
  • Sarcoid
  • Syphilis.

Treatment

These are the most common methods of treatment chosen to lower the elevated levels of alkaline phosphatase:

  • Treatment of the underlying condition
    • Once the correct cause has been identified and treated, the levels of alkaline phosphatase are going to go back to normal
  • Removal of medication that might be causing the increased levels of alkaline phosphatase:
    • Birth control pills
    • Anti-inflammatory medication
    • Narcotic medication
    • Hormonal drugs
    • Steroids
    • Antidepressants
    • Hypertension medication
  • Dietary changes
    • Avoid foods that are rich in zinc
    • Elimination of foods that are rich in vitamin B12 from the diet
    • The foods that are allowed to be included in the diet include: dairy products (milk, eggs), fish (tuna, sardines, mackerel, herring), fish oil (preferably from cod), alfalfa, mushrooms
    • The foods that you should eliminate from the diet include: meat (especially beef, pork and lamb), certain vegetables (lentils), cheese, shellfish, different types of oil (corn, coconut) and beverages that are fizzy or sugary
  • Lifestyle change
    • Healthy diet in association with physical exercise
    • Exposure to sunlight (stimulates the production of vitamin D).

In conclusion, the level of alkaline phosphatase in the body can provide information on a wide range of medical conditions. The elevated levels of alkaline phosphatase can be identified through a simple blood test, guiding the doctor on the most appropriate treatment for the respective condition. In general, it is not sufficient to take medication, in order to improve the levels of alkaline phosphatase. As it was mentioned above, you also have to change your diet and become more physically active. As these levels are often encountered in patients who suffer from vitamin D deficiency, you also need to spend more time in the sun.

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