Fracture Risk is much more than Bone Mineral Density and t-score. Bone Health is affected by many medical conditions. That is why we check blood tests.
Alkaline Phosphatase (alk phos) is the most interesting serum (blood) enzyme because it is produced in liver, bone, intestine and placenta. High alk phos can mean rapid bone formation. If Bone Alk Phos is high, we need to determine why. Most commonly bone alk phos is high in bone healing after a fracture or orthopedic surgery, and will return to normal within 6 months.
Occasionally there is Paget’s Disease. Paget’s is runaway bone turnover, usually just in a few portions of a few bones. We may need a bone scan to identify where it is. We evaluate with X-rays, and may need a CT. Paget’s is treated with Antiresorptives.
Rarely we find metastatic tumor spread to bone from breast, prostate, colon, lung, or other tissue. Very rarely there is a primary tumor of bone (less than 1 in 200,000 patients).
When Alk Phos is high, we get Isoenzymes to determine which tissue is responsible. If liver alk phos is high, I refer to a medical practitioner. SGOT, SGPT, and LDH are other enzymes produced mainly by the liver. Some medications, such as statins, and some diseases, can cause liver enzymes to be high. Biliruben can be high in gallbladder disease.
We need to treat all medical conditions for optimal bone health and to reduce Fracture Risk. That’s why we look. More next time.
Jay Ginther, MD