asymptomatic raised alkaline phosphatase

Last edited 09/2019 and last reviewed 04/2022

The elevation of alkaline phosphatase levels in an asymptomatic individual should be confirmed by anlysis of a repeat blood sample.

Chronic elevation of alkaline phosphatase levels in an otherwise well individual may be:

  • a variant of normal
  • due to bone disease
  • due to liver disease:
    • liver disease is supported by elevated gamma-GT levels

Sometimes it is useful to look at the relationship of ALP to bilirubin and lactate dehydrogenase (LD) levels (1)

Pathology Alkaline Phosphatase Bilirubin LD
Intra or extrahepatic cholestasis Increased Increased Normal
Focal benign cholestasis Increased Normal Normal
Focal malignant cholestasis Increased Normal Increased


  • if alkaline phosphatase is raised in an asymptomatic patient and serum bilirubin, liver transaminases, creatinine, adjusted calcium, thyroid function, and blood count are normal (2):

    • consider growth spurts in adolescents, pregnancy in women, drugs, and age related increases
    • as most likely sources are either bone or liver, differentiate by measuring GGT (raised in liver) and investigate accordingly
    • for liver cases investigate with abdominal ultrasound scan (cholestasis and hepatic space occupying lesion) and antimitochondrial antibodies (primary biliary cirrhosis)
    • for bone cases investigate vitamin D