Elevated Total Alkaline Phosphatase Levels linked to increased risk of Osteoporosis and Mortality: Study
Elevated levels of serum total alkaline phosphatase (T-ALP) have been linked with decreased bone mineral density (BMD), higher prevalence of osteoporosis, and higher mortality rate in patients with osteoporosis. This was concluded in a recent study published in the journal Osteoporosis International conducted by Ran Chen and colleagues.
Data were analyzed from 13,724 adults aged 18 to 85 years who had participated in National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. Mortality data were obtained from the National Death Index through December 31, 2019. Serum T-ALP levels were correlated with BMD at the femoral neck and lumbar spine using linear regression models, subgroup analysis, and weighted logistic regression. Of participants diagnosed with osteoporosis (n = 944), survival analysis, including Kaplan-Meier curves and Cox proportional hazards models, was applied to examine how serum T-ALP could predict mortality.
The study had a number of important findings:
• High serum T-ALP levels were correlated strongly with low BMD both at the femoral neck and the lumbar spine. In fact, this correlation was apparent across all subgroups which include age, sex, race, and BMI
Osteoporosis Prevalence :
• The prevalence of osteoporosis in each 1 SD increase for T-ALP values was increased by 0.5% [Odds Ratio (OR) : 1.005; 95% CI : 1.005–1.005 ; p < 0.001].
• Participants with serum T-ALP levels at the highest tertile (>79 IU/L) had a risk of 29.2% to develop osteoporosis than those in the lowest tertile (<53 IU/L) [OR: 1.292; 95% CI: 1.021–1.636; p = 0.033].
All-Cause Mortality of Osteoporosis
• In subjects with osteoporosis, with every increase in 1 SD in the T-ALP values, there was an increase of 0.4% in all-cause mortality [HR: 1.004; 95% CI: 1.002–1.006; p < 0.001].
• The highest T-ALP category was associated with a 23.2% higher mortality risk than the lowest category [HR: 1.232; 95% CI: 1.041–1.459; p = 0.015].
The current study emphasizes the fact that serum T-ALP levels significantly correlate with low BMD, a higher prevalence of osteoporosis, and all-cause mortality in patients suffering from osteoporosis. Regular assessment of T-ALP levels in clinical practice could provide valuable information for assessing risk and enhancing outcomes in such patients.
Reference:
Chen R, Gong K, Chen W, Chen Z, Hua X, Tan J, Tian Y, Liu D, Zhang L, Tang Y, Li Y, Zhou S. Association of serum alkaline phosphatase levels with bone mineral density, osteoporosis prevalence, and mortality in US adults with osteoporosis: evidence from NHANES 2005-2018. Osteoporos Int. 2024 Nov 29. doi: 10.1007/s00198-024-07324-w. Epub ahead of print. PMID: 39611944.
