Alkaline Phosphatase (ALP)
Other names: Alk Phos
What is Alkaline Phosphatase (ALP)?
Alkaline phosphatase (ALP) is an enzyme found throughout your body. It plays an essential role in bone growth and liver function. Most of the ALP in your blood comes from your liver, bile ducts, and bones, but smaller amounts are also produced by the intestines, kidneys, and placenta (during pregnancy).
Because ALP is made in multiple organs, changes in its level can give important clues about liver health, bone metabolism, bile duct function, and nutrient status.
Why is ALP important?
ALP helps your body:
• Build and remodel bones
• Support proper liver and bile duct function
• Transport minerals like calcium and phosphate
• Maintain healthy cell membranes and metabolic reactions
Higher or lower-than-normal ALP can signal an underlying condition affecting the liver, bones, or metabolism.
What does the ALP blood test measure?
An ALP blood test measures the amount of alkaline phosphatase circulating in your bloodstream.
It is commonly included in:
• Liver panel
• Comprehensive Metabolic Panel (CMP)
• Bone metabolism evaluations
Because ALP alone cannot pinpoint where it is coming from, your healthcare provider often interprets it alongside other markers such as:
• AST & ALT (liver enzymes)
• GGT or 5′-nucleotidase (bile duct markers)
• Calcium, phosphate, vitamin D (bone markers)
In some cases, an ALP isoenzyme test may be done to identify the specific source (bone vs liver), although this is not routinely performed in most labs.
When is ALP testing recommended?
Your clinician may order ALP if you have symptoms of:
Liver or bile duct disease
• Fatigue
• Jaundice (yellow skin/eyes)
• Abdominal pain
• Nausea or loss of appetite
• Dark urine or pale stools
Bone disorders
• Bone pain or tenderness
• Frequent fractures
• Abnormal bone shape or density
• Vitamin D deficiency symptoms
ALP may also be monitored if you are taking medications that can affect the liver.
Normal ALP ranges
Reference ranges vary by lab, age, and pregnancy status.
| Group | Typical Range |
|---|---|
| Adults | 39 – 117 IU/L |
| Children & Adolescents | Up to ~350 IU/L (higher due to bone growth) |
| Pregnancy | Levels rise naturally, especially in the 3rd trimester |
Always compare your level to the lab range printed on your report.
What does it mean if your Alkaline Phosphatase (ALP) result is too high?
An elevated ALP level is more common than a low level, and may indicate increased activity in the liver or bones.
Common causes
Liver & bile duct conditions
• Blocked bile ducts / gallstones
• Hepatitis
• Cirrhosis
• Fatty liver disease
• Primary biliary cholangitis (PBC)
• Liver cancer or metastases
Bone-related causes
• Vitamin D deficiency
• Osteomalacia / Rickets
• Paget’s disease
• Bone healing after fracture
• Bone cancer or cancer spread to bone
Normal physiological elevations
• Growth spurts in children and teens
• Third trimester of pregnancy
• After a fatty meal in certain blood types
What to do next
If your ALP is high, your clinician may order:
• GGT or 5′-NT (to confirm liver origin)
• Vitamin D, calcium, phosphate
• Liver ultrasound or advanced imaging
• Viral hepatitis tests
• Autoimmune liver tests (such as AMA for PBC)
Mild isolated increases are often monitored over time.
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What does it mean if your Alkaline Phosphatase (ALP) result is too low?
Low ALP levels are less common but can also be clinically meaningful.
Possible causes
• Malnutrition or protein deficiency
• Zinc or magnesium deficiency
• Hypothyroidism
• Pernicious anemia (B12 deficiency)
• Celiac disease
• Severe anemia
• Wilson’s disease (rare)
Rare genetic condition:
Hypophosphatasia (HPP) – a metabolic bone disorder causing extremely low ALP and poor bone mineralization.
If ALP is persistently low, your clinician may check vitamin B6, bone density, genetic markers, and nutrient levels.
Medications that may affect ALP levels
Some drugs can increase or decrease ALP, including:
• Hormonal contraceptives
• Corticosteroids
• Antiseizure medications (e.g., phenytoin)
• NSAIDs (ibuprofen, naproxen)
• Some antibiotics
• Androgen or estrogen therapies
Always tell your provider about any medications or supplements you take.
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