How do you approach a patient with elevated bone specific ALP (>2X the normal limit), but no other evidence of Paget's disease?

Normal Vitamin D, bone scan showed osteoarthritis

Answer from: at Academic Institution

There are other causes of elevated bone alkaline phosphatase e.g. osteomalacia. Check blood calcium, magnesium and phosphate, PTH and 25-OH-vitamin D. If PTH is elevated and no CKD, check 24-hour urinary calcium and creatinine.

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at SUNY Upstate Medical University
Thank you.

at Uniformed Services University of the Health Sciences (USUHS)
I'd also add a TSH; I'd also get directed x-rays (...

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How do you approach a patient with elevated bone specific ALP (>2X the normal limit), but no other evidence of Paget's disease?

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