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SERUM ALAKALINE PHOSPHATASE - CHEAPEST METHOD TO DIAGNOSE OSTEOMALACIA
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Osteomalacia should be thought of in young women who have delivered few children and are housebound and go out in the sun very infrequently. However, osteomalacia can occur in older women living in the same conditions in whom we are suspecting osteoporosis, but an incidental finding of raised Alkaline Phosphatase brings out the diagnosis of "associated" osteomalacia.
Even elderly housebound males can suffer from this illness. However, in elderly people, do not forget to rule out Padget’s Disease or secondary metastatic bony deposits. X-rays confirming osteomalacia become positive quite late in the evolution of this disease. Therefore the diagnosis is made by the Serum Alkaline Phosphatase blood test.
Serum Calcium levels often fall very late while Vit. D levels fall very early. By the time this occurs, PTH (Parathyroid hormone - Intact) levels start rising. However, the cost of doing both these tests (Vit. D and PTH levels) is very high (Rs. 800-1000/- each) while the cost of blood test for Serum Alkaline Phosphatase is only Rs. 100/-. The only snag is that this enzyme is also raised in liver disease and many other conditions.
However, if the family physicians ask for the blood test of Serum Alkaline Phosphatase stable fraction known as Bone Fraction which is being done in a few laboratories, the cost comes to only Rs. 180/-. This blood test should be enough to make the diagnosis of osteomalacia in majority of the patients in whom you are suspecting this disease. Of course in rich patients, Vit. D levels and even PTH (I) levels may also be asked for.
ACKNOWLEDGEMENT
I am thankful to Dr. Sanjiv Amin for sharing his experience with me.
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