Aging Clinical and Experimental Research

, Volume 27, Issue 4, pp 413–418 | Cite as

Elevation of serum alkaline phosphatase (ALP) level in postmenopausal women is caused by high bone turnover

  • Keijiro MukaiyamaEmail author
  • Mikio Kamimura
  • Shigeharu Uchiyama
  • Shota Ikegami
  • Yukio Nakamura
  • Hiroyuki Kato
Original Article



Most of the alkaline phosphatase (ALP) isoenzymes are derived from the bones and liver. High levels of ALP are often encountered during routine blood investigation in elderly patients. However, because ALP includes various isoenzymes from other tissues, an accurate diagnosis is usually not possible on the basis of elevated ALP alone.


To identify the cause of increased ALP in postmenopausal women.


We measured serum ALP in a group of 626 postmenopausal osteoporotic women before and after treatment with a bisphosphonate (either alendronate or risedronate). We analyzed the correlations between ALP levels and bone metabolic markers or hepatic function markers.


The ALP and BAP levels of people in their 80s were significantly higher than those of people in their 60s. With bisphosphonate therapy, the BAP decreased, and the elevated ALP decreased to normal range levels. ALP was highly and significantly correlated with BAP both before and after treatment. The changes in levels of ALP correlated well with the changes in BAP levels before and after bisphosphonate therapy. Markers of liver function correlated with total ALP (p < 0.01), but the correlation was much smaller than that between ALP and BAP.


Bisphosphonate treatment lowered ALP levels, and this decrease was strongly correlated with a decrease in BAP. Among blood test data, the decrease in BAP had the strongest correlation with the ALP decrease.


For treatment of osteoporosis, ALP is an acceptable alternative to BAP. Elevated ALP in postmenopausal women is mainly caused by high bone turnover.


Alkaline phosphatase Menopausal women Osteoporosis Bone turnover 


Conflict of interest

There are no conflicts of interest or support to declare regarding this work.


  1. 1.
    Fleisher GA, Eickelberg ES, Elveback LR (1977) Alkaline phosphatase activity in the plasma of children and adolescents. Clin Chem 23:469–472PubMedGoogle Scholar
  2. 2.
    Cheng MH, Lipsey AI, Blanco V, Wong HT, Spiro SH (1979) Microchemical analysis for 13 constituents of plasma from healthy children. Clin Chem 25:692–698PubMedGoogle Scholar
  3. 3.
    Cherian AG, Hill JG (1978) Age dependence of serum enzymatic activities (alkaline phosphatase, aspartate aminotransferase, and creatine kinase) in healthy children and adolescents. Am J Clin Pathol 70:783–789PubMedGoogle Scholar
  4. 4.
    Whitaker KB, Whitby LG, Moss DW (1977) Activities of bone and liver alkaline phosphatases in serum in health and disease. Clin Chim Acta 80:209–220PubMedCrossRefGoogle Scholar
  5. 5.
    Statland BE, Nishi HH, Young DS (1972) Serum alkaline phosphatase: total activity and isoenzyme determinations made by use of the centrifugal fast analyzer. Clin Chem 18:1468–1474PubMedGoogle Scholar
  6. 6.
    Schiele F, Henny J, Hitz J, Petitclerc C, Gueguen R, Siest G (1983) Total bone and liver alkaline phosphatases in plasma: biological variations and reference limits. Clin Chem 29:634–641PubMedGoogle Scholar
  7. 7.
    Gardner MD, Scott R (1978) Frequency distribution and ‘reference values’ of plasma alkaline phosphatase (EC activity in the adult population of a Scottish new town. J Clin Pathol 31:1202–1206PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Kelly A, Munan L, PetitClerc C, Plante G, Billon B (1979) Patterns of change in selected serum chemical parameters of middle and later years. J Gerontol 34:37–40PubMedCrossRefGoogle Scholar
  9. 9.
    Nishida T (2001) Age changes of clinical laboratory test result. Rinsho-Kensa 45:353–358Google Scholar
  10. 10.
    Orimo H, Hayashi Y, Fukunaga M, Sone T, Fujiwara S, Shiraki M et al (2001) Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab 19:331–337PubMedCrossRefGoogle Scholar
  11. 11.
    Endo N (2007) A definition and the diagnostic criteria for osteoporosisGoogle Scholar
  12. 12.
    Orimo H (2006) Guidelines for the prevention and treatment of osteoporosis 2006Google Scholar
  13. 13.
    Iino S (1995) Biochemical test including isozymes, alkaline phosphatase (ALP). Nippon-Rinsho 53:276–279PubMedGoogle Scholar
  14. 14.
    Kuwa K (1993) A trend of the enzyme test standardization. Rinsho-Kensa 37:473–478Google Scholar
  15. 15.
    Kuwana T, Sugita O, Yakata M (1988) Reference limits of bone and liver alkaline phosphatase isoenzymes in the serum of healthy subjects according to age and sex as determined by wheat germ lectin affinity electrophoresis. Clin Chim Acta 173:273–280PubMedCrossRefGoogle Scholar
  16. 16.
    Gallagher JC, Kinyamu HK, Fowler SE, Dawson-Hughes B, Dalsky GP, Sherman SS (1998) Calciotropic hormones and bone markers in the elderly. J Bone Miner Res 13:475–482PubMedCrossRefGoogle Scholar
  17. 17.
    Dresner-Pollak R, Parker RA, Poku M, Thompson J, Seibel MJ, Greenspan SL (1996) Biochemical markers of bone turnover reflect femoral bone loss in elderly women. Calcif Tissue Int 59:328–333PubMedCrossRefGoogle Scholar
  18. 18.
    Woitge HW, Scheidt-Nave C, Kissling C, Leidig-Bruckner G, Meyer K, Grauer A et al (1998) Seasonal variation of biochemical indexes of bone turnover: results of a population-based study. J Clin Endocrinol Metab 83:68–75PubMedGoogle Scholar
  19. 19.
    Nishizawa Y, Nakamura T, Ohta H, Kushida K, Gorai I, Shiraki M et al (2005) Guidelines for the use of biochemical markers of bone turnover in osteoporosis (2004). J Bone Miner Metab 23:97–104PubMedCrossRefGoogle Scholar
  20. 20.
    Takahara K, Kamimura M, Nakagawa H, Uchiyama S (2004) Changes in biochemical markers of bone in patients with insufficiency fractures. J Bone Miner Metab 22:618–625PubMedCrossRefGoogle Scholar
  21. 21.
    Takahara K, Nakagawa H, Kamimura M, Hashidate H, Kawaguchi A, Uchiyama S (2004) Unusual stress fracture of the femoral neck in a young adult not caused by excessive stress: a case report. J Orthop Sci 9:650–653PubMedCrossRefGoogle Scholar
  22. 22.
    Hosking DJ (1978) Changes in serum alkaline phosphatase after femoral fractures. J Bone Joint Surg Br 60:61–65PubMedGoogle Scholar
  23. 23.
    Ingle BM, Hay SM, Bottjer HM, Eastell R (1999) Changes in bone mass and bone turnover following distal forearm fracture. Osteoporos Int 10:399–407PubMedCrossRefGoogle Scholar
  24. 24.
    Nakagawa H, Kamimura M, Takahara K, Hashidate H, Kawaguchi A, Uchiyama S et al (2006) Changes in total alkaline phosphatase level after hip fracture: comparison between femoral neck and trochanter fractures. J Orthop Sci 11:135–139PubMedCrossRefGoogle Scholar
  25. 25.
    Kamimura M, Uchiyama S, Takahara K, Hashidate H, Kawaguchi A, Nakagawa H (2005) Urinary excretion of type I collagen cross-linked N-telopeptide and serum bone-specific alkaline phosphatase analysis to determine the correlation of age and back-pain related changes in elderly women. J Bone Miner Metab 23:495–500PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Keijiro Mukaiyama
    • 1
    Email author
  • Mikio Kamimura
    • 2
  • Shigeharu Uchiyama
    • 1
  • Shota Ikegami
    • 1
  • Yukio Nakamura
    • 1
  • Hiroyuki Kato
    • 1
  1. 1.Departments of Orthopaedic SurgeryShinshu University School of MedicineMatsumoto CityJapan
  2. 2.Kamimura ClinicMatsumoto CityJapan

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