A low serum alkaline phosphatase may signal hypophosphatasia in osteoporosis clinic patients

被引:7
作者
Ng, Elisabeth [1 ,2 ]
Ashkar, Claudia [1 ]
Seeman, Ego [3 ,4 ]
Schneider, Hans G. [1 ,5 ,6 ]
Nguyen, Hanh [2 ,7 ]
Ebeling, Peter R. [2 ,7 ]
Sztal-Mazer, Shoshana [1 ,6 ]
机构
[1] Alfred Hlth, Dept Endocrinol & Diabet, Melbourne, Vic, Australia
[2] Monash Hlth, Dept Endocrinol, Clayton, Vic, Australia
[3] Univ Melbourne, Dept Med, Melbourne, Vic, Australia
[4] Austin Hlth, Dept Endocrinol, Melbourne, Vic, Australia
[5] Alfred Pathol Serv, Clin Biochem Unit, Alfred Hlth, Melbourne, Vic, Australia
[6] Monash Univ, Sch Publ Hlth & Preventat Med, Melbourne, Vic, Australia
[7] Monash Univ, Sch Clin Sci, Dept Med, Clayton, Vic, Australia
关键词
Alkaline phosphatase; Bisphosphonate; Hypophosphatasemia; Hypophosphatasia; Osteoporosis; DIAGNOSIS; SPECTRUM; BURDEN; ADULTS; LEVEL;
D O I
10.1007/s00198-022-06597-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A Summary Low serum alkaline phosphatase (ALP) was found in 9% of patients attending an osteoporosis clinic, 0.6% of hospital patients, and 2/22 with an atypical femoral fracture. Hypophosphatasia was diagnosed in 3% of osteoporosis clinic patients with low ALP. Low ALP is a screening tool for hypophosphatasia, a condition potentially aggravated by antiresorptive therapy. Introduction Hypophosphatasia (HPP) is an inherited disorder associated with impaired primary mineralisation of osteoid (osteomalacia). HPP may be misdiagnosed as osteoporosis, a reduction in the volume of normally mineralized bone. Both illnesses may result in fragility fractures, although stress and atypical fractures are more common in HPP. Antiresorptive therapy, first-line treatment for osteoporosis, is relatively contraindicated in HPP. Misdiagnosis and mistreatment can be avoided by recognising a low serum alkaline phosphatase (ALP). Our aim was to determine the prevalence of a low ALP (<30 IU/L) in patients attending an osteoporosis clinic, in a hospital-wide setting, and in a group of patients with atypical femoral fractures (AFF). Methods This was a retrospective study of patients attending an osteoporosis clinic at a tertiary hospital during 8 years (2012-2020). Patients were categorised into those with a transiently low ALP, those with low ALP on >= 2 occasions but not the majority of measurements, and those with a persistently low ALP. ALP levels were also assessed in hospital-wide records and a group of patients with AFF. Results Of 1839 patients attending an osteoporosis clinic, 168 (9%) had >= 1 low ALP, 50 (2.7%) had low ALP for >= 2 months, and seven (0.4%) had persistently low ALP levels. HPP was diagnosed in five patients, four of whom had persistently low ALP levels. The prevalence of HPP was 0.3% in the osteoporosis clinic and 3% in patients with >= 1 low ALP. Low ALP occurred in 0.6% of all hospital patients and 2/22 with AFF. Conclusion Persistently low ALP in osteoporosis clinic attendees is easy to identify and signals the possibility of hypophosphatasia, a condition that may be mistaken for osteoporosis and incorrectly treated with antiresorptive therapy.
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收藏
页码:327 / 337
页数:11
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