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What does elevated Alkaline Phosphatase level mean?

Posted On : March 18, 2014
Alkaline phosphatase (ALP) is on enzyme that is produced mostly by the liver and bones.  There are other organs in an adult that produce alkaline phosphatase including the kidneys and the small bowel. Placental of a pregnant female also produces some alkaline phosphatase. The amount of alkaline phosphatase produced by the liver is more than the combined level of alkaline phosphatase by all other sources in an adult.

There are laboratory studies that can distinguish between 2 primary sources of the ALP.  The two “isoenzymes” are bone ALP and liver ALP.

The presence of an elevated level alkaline phosphatase is significant in post weight loss surgical patients because of its relationship to calcium and vitamin D absorption.  When a patient has inadequate calcium and vitamin D absorption (or intake) this will result in elevation of the parathyroid hormone (PTH).   Elevated level of parathyroid hormone will the cause, increased bone breakdown, increased absorption of calcium from the GI tract, increased resorption of the calcium from the kidneys.  All of these measures are to normalize the level of the calcium in the blood.  One of the byproducts of bone breakdown is alkaline phosphatase. 
When the patient has an elevated ALP consideration should be given to liver sources including biliary obstruction.  In post duodenal switch operation this can only be studied by a magnetic resonance cholangiopancreatography (MRCP.)  Patients with a duodenal switch operation cannot have an endoscopic retrograde cholangiopancreatography (ERCP.) Needless to say broader range of liver function tests should also be evaluated.

Parathyroid hormone level, vitamin D 25-OH level and calcium level will also be needed in order to evaluate the possible cause off calcium malabsorption as the underlying reason for elevated alkaline phosphatase by the mechanism described above.  A typical patient may have an elevated parathyroid level, low calcium and low vitamin D level.

16 responses to “What does elevated Alkaline Phosphatase level mean?”

  1. If there is a family history of hyperparathyroidism and the patient had the DS, should a PTH of 83, an ALP of 138, a D of 89 and Calcium of 9.5 raise concerns. I am 7 years post-op, have regained a lot of the weight, had normal urine levels and am very concerned. Anyone have any thoughts?

  2. Dr. K
    56 yr. Old female. POST Gastric Sleeve 11 month.
    Rhuematoid arthritis on Orinzia.
    Most recent lab results ALP 159, bone is 15%, intestinal iso 0%, liver is 61%, Macropatic isoenzymes 24%

    In post op sleeve patients on a high protein diet are these elevations typical?

  3. 54 year old female. Gastric bypass (Roux-en-y) in 2001. 16 years ago. Alkaline phosphatase is high 216. Parathyroid is high 65. Calcium is normal 9.4. Vitamin D normal 59. Alkaline phosphatase, bone specific is normal 24.4. Creatinine is normal 0.62. Creative kinase total is normal 40. Started having bone and muscle several months ago. Fatigue and generally not feeling well. Started having chronic diarrhea 2 years ago. What’s going on? I am worried.

    • There are many other reasons why the talk pos may be elevated. Please see your PCP for further evaluation and workup.

  4. 72 year old female, Gastric-By-Pass surgery in 1989 lost over 250 lbs. but still Obese . Thyroid Cancer in 1989, reoccurred in 1993. Had I-131 3 times. Have Osteoporosis , and Arthritis , my ALK PHOS is at 290 and has been high for 6 years. Liver scan shows nothing wrong what might be causing the high ALK PHOS.

    • The elevated ALK Phos may mean a number things. There is really no way to answer this questions without having more information. Recommend that you see your PCP.

  5. Hi
    I have oestopenia and recently was found high alk phos (128u/l) and high calcium (10.5). pth intact 54.8pg/ml. (high) Retested a month later, still high pth, but calcium at 10. Alk still high too. I have not felt well for a longer period of time now, have inflamed thyroid as well. Fibroid discovered. Feel fatigued, have muscle on and off muscle twitching….heart palpitations, positive non specific ANA. Since 2018, I have had a lump in my throat that is there constantly. Any ideas? I just want to go back to my old self….happy and not stressed out from this problem.

    • Hello, There are probably a few things that need to be addressed. Elevated Alk Phos may mean that you are not absorbing enough Calcium and are low on Vitamin D. The labs that you have reported may also warrant checking the parathyroid glands with a scan. Please see your Primary care and very likely need to see an endocrinologist. Remember to be safe and self isolate and wear a mask all the time when outside.


    • There are two sources of alkaline phosphatase- liver and bone. In either case, someone needs to stay on top of it. There are further blood tests that can be drawn to distinguish between them.

  7. I have just turned 90 and have recently had blood work done. My Alkaline Phosphatases is listed high (139, was 131 in 4/2023, blood glucose 115 , do know I have recently consumed many sweets, last A1c was 5.6) I live alone and manage to drive for grocery shopping and to doctor appointments. I do have an aortic leak and lymphedema which is being treated with Bio-Compression boots daily. I do see a doctor every 6 months regularly. Should I be concerned?

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