Alkaline phosphatase bone specific

[Marcia K]

Good afternoon, Tex. The results of my bloodwork ordered by the PA at the Rheumatologist are coming in. My alkaline phosphatase bone specific is 27.3. The range is 5.6-29.0. I Googled and a high number could indicate bone cancer or Osteomalacia, etc. I believe having an IBD can cause the number to be high. I wanted to ask your opinion as I want to be fully prepared for my return visit with the PA as she's going to push the Reclast.
Thanks so much!

[tex]

Hi Marcia,

Here are my thoughts on that test result:

Bone-specific alkaline phosphatase reflects bone formation activity. A result of 27.3 is at the upper end of normal, but not elevated.

Active MC is often linked with low bone density and higher osteoporosis risk, mainly because of:

Chronic inflammation
Nutrient malabsorption (especially calcium, vitamin D, magnesium)
Steroid use (like budesonide or prednisone)

So during active disease, malabsorption and inflammation could disrupt bone metabolism.

But if you're in remission, and you’re absorbing nutrients normally (and not on steroids), MC by itself usually doesn’t cause abnormal bone-specific alkaline phosphatase levels.

Regarding a test level of 27.3: Some people just run high-normal). It could reflect bone turnover related to postmenopausal status, growth/repair, or recovery from a recent fracture. A recent vitamin D or calcium deficiency correction (in other words, if your body is rebuilding bone) bone-specific alkaline phosphatase may temporarily rise.

A level just below 29.0, with no other abnormal labs, is nothing to worry about.

Note that bone-specific alkaline phosphatase typically drops by 30–50% within 3–6 months after a Reclast infusion. That's how doctors determine whether or not the drug is working properly.

In case you're interested, I looked up the risks associated with an unnecessary Reclast infusion (you're probably already aware of most of these).

1. Immediate Risks (After Infusion)

Flu-like symptoms (fever, muscle aches, fatigue, headache) within 1–3 days.
Occurs in up to 30–40% of first-time users; usually mild and short-lived, but unpleasant.
Infusion reactions: Rarely, chest pain, shortness of breath, or arrhythmias can occur during or right after infusion.

2. Short-Term Laboratory Effects

Hypocalcemia (low calcium levels): Can be significant in patients with low vitamin D, low calcium intake, or malabsorption (for example, from MC).
Kidney stress: Zoledronic acid is excreted through the kidneys; it can cause acute kidney injury, especially in people with preexisting kidney disease, dehydration, or on nephrotoxic drugs.

3. Long-Term or Cumulative Risks

Over-suppression of bone turnover:

If bone density is already adequate, unnecessary suppression may impair microrepair of bone. This is thought to contribute to rare femoral fractures (stress fractures in the thigh bone) after long-term use.
Osteonecrosis of the jaw (ONJ): Very rare in osteoporosis treatment (<1 in 10,000), but risk is higher with invasive dental procedures or poor oral health.
Possible atrial fibrillation link: Some studies suggested a small increase in AFib risk, though data are inconsistent.

4. The Key Issue: Loss of Benefit vs. Risk of Harm

If a patient doesn’t actually have osteoporosis or high fracture risk, then no meaningful benefit is gained.
But the downsides (flu-like illness, kidney risk, rare jaw/atypical fractures, unnecessary cost) remain.
Essentially, it’s exposing someone to drug risk without offsetting benefit.

The Bottom Line

If given when not needed, Reclast:

Suppresses normal bone turnover unnecessarily.
Carries risks of acute flu-like reaction, kidney injury, hypocalcemia, rare jaw necrosis, or atypical femur fracture.
Provides no protective benefit against fractures in someone who isn’t at risk.

This is why guidelines from the National Osteoporosis Foundation, and Endocrine Society recommend Reclast only for:

Patients with osteoporosis, or those with osteopenia and high fracture risk (per FRAX or prior fragility fracture).

At least that's my opinion, for what it's worth.

Wayne

[Marcia K]

Thank you so much for thorough response. The bottom line says it all. I am not at risk for fracture. I am able to stand on one leg for a minute and I will continue to work on maintaining good balance as I know that falling puts us at risk for fracture.
Once again I am very grateful for your help in navigating this life with LC. This group has been invaluable to me for many years now.