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Clinical manifestations and low alkaline phosphatase (ALP) activity can confirm a diagnosis of hypophosphatasia (HPP).1,2

Detection of low alkaline phosphatase activity in patients with clinical manifestations of hypophosphatasia can lead to an accurate diagnosis.1,2

Low alkaline phosphatase can be identified with a readily available, routine laboratory test1,2,28
Alkaline phosphatase activity should be age-adjusted and is laboratory-specific2

Early and accurate diagnosis is essential to avoid preventable morbidities and premature mortality.26,29,30

aSerum PLP (vitamin B6) is the most sensitive alkaline phosphatase substrate marker for hypophosphatasia, though it may not be elevated in all patients.2

Hypophosphatasia is inherited, so a diagnosis should raise suspicion of the disease in other family members.1,2

In family members with clinical signs and symptoms of hypophosphatasia, a routine test for low alkaline phosphatase activity can confirm a diagnosis.1

Family members of patients may have undiagnosed hypophosphatasia.2,21

The alkaline phosphatase lower limit of normal is significantly higher in children than in adults.31,32

Growth and development profoundly affect the normal range for alkaline phosphatase.31,33

Adapted from the Canadian Laboratory Initiative on Paediatric Reference Intervals (CALIPER) project (Colantonio et al, 2012). No variation in ALP based on ethnic differences was observed. Reference intervals shown were established on the Abbott ARCHITECT C8000 analyzer.31

bAdult interval provided by the Abbott ARCHITECT ALP product information sheet is for females >15 and males >20 years of age. For younger ages, Abbott does not provide lower limits of normal.32

Confirm that your laboratory is using age- and gender-adjusted alkaline phosphatase reference intervals.

Low alkaline phosphatase is the biological hallmark of hypophosphatasia.1,3 Growth and development profoundly affect the normal range for alkaline phosphatase.31,33


To assess your patient's alkaline phosphatase level, select your patient's gender, and enter his or her age and alkaline phosphatase value.

Reference intervals shown are relevant to the Abbott ARCHITECT c8000 analyzer and may vary across individual laboratories.
You must indicate gender, age, and ALP value.
References: 1. Colantonio DA, Kyriakopoulou L, Chan MK, et al. Closing the gaps in pediatric laboratory reference intervals: a CALIPER database of 40 biochemical markers in a healthy and multiethnic population of children. Clin Chem. 2012;58(5):854-868. doi: 10.1373/clinchem.2011.177741. Epub 2012 Feb 27. 2. Rockman-Greenberg C. Hypophosphatasia. Pediatr Endocrinol Rev. 2013;10(suppl 2):380-388. 3. Whyte MP. Physiological role of alkaline phosphatase explored in hypophosphatasia. Ann N Y Acad Sci. 2010;1192:190-200. 4. Shipman KE, Holt AD, Gama R. Interpreting an isolated raised serum alkaline phosphatase level in an asymptomatic patient. BMJ. 2013;346:f976 doi: 10.1136/bmj.f976. 5. Whyte MP. Hypophosphatasia. In: Glorieux FH, Pettifor JM, Juppner H, eds. Pediatric Bone: Biology & Diseases Rev. 2nd ed. San Diego, CA: Academic Press; 2012:771-794. 6. Whyte MP. Hypophosphatasia: nature’s window on alkaline phosphatase function in humans. In: Bilezikian JP, Raisz LG, Martin TJ, eds. Principles of Bone Biology. Vol 1. 3rd ed. San Diego, CA: Academic Press; 2008:1573-1598. 7. Estey MP, Cohen AH, Colantonio DA, et al. CLSI-based transference of the CALIPER database of pediatric reference intervals from Abbott to Beckman, Ortho, Roche and Siemens Clinical Chemistry Assays: direct validation using reference samples from the CALIPER cohort. Clin Biochem. 2013;46(13-14):1197-1219. doi: 10.1016/j.clinbiochem.2013.04.001. Epub 2013 Apr 8. 8. Nield LS, Mahajan P, Joshi A, Kamat D. Rickets: not a disease of the past. Am Fam Physician. 2006;74(4):619-630. 9. Simmons JH. Best practices in: recognizing and diagnosing hypophosphatasia. Clinical Endocrinology News website. Published September 30, 2013. Accessed June 26, 2015. 10. Bhan A, Rao AD, Rao DS. Osteomalacia as a result of vitamin D deficiency. Endocrinol Metab Clin North Am. 2010;39(2):321-331. doi: 10.1016/j.ecl.2010.02.001. 11. Lab Tests Online. Liver panel. Published February 24, 2015. Accessed September 24, 2015. 12. Mornet E, Nunes ME. Hypophosphatasia. In: Pagon RA, Bird TD, Dolan CR, Stephen K, eds. GeneReviews. Seattle, WA: University of Washington, Seattle; 1993. Published November 20, 2007. Updated August 5, 2010. Accessed June 26, 2015.


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