Compare your patient’s current and historical ALP levels from their comprehensive metabolic panel against normal age- and sex-adjusted references ranges.
Leave Blank if unknown
Based on the age- and sex-adjusted reference range
ALP Activity (U/L)
High = over XXX U/L
Normal = XXX U/L
Low = under XXX U/L
Low ALP
Normal ALP
Leave Blank if unknown
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After reviewing this information, how confident are you in considering a diagnosis of HPP in patients with perplexing symptoms and persistently low age- and sex-adjusted ALP?
Now is the time to review your patient’s history to determine whether a diagnosis of HPP could be appropriate. Your confidence will help your patients with HPP get an early and accurate diagnosis, which is so crucial to managing this disease.
When it comes to HPP, there’s so much to know. Connect your patient with a comprehensive disease management team that specializes in HPP, and check out these pages to learn more: What is HPP?, Symptoms, Patient Types.
When it comes to HPP, there’s so much to know. Connect your patient with a comprehensive disease management team that specializes in HPP, and check out these pages to learn more: What is HPP?, Symptoms, Patient Types.
NOTE: Reference range was taken from the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) Database which compiled age- and sex-specific reference intervals in a pediatric population.3
*Clinicians should ensure that reported laboratory results for ALP reflect age- and sex-adjusted reference ranges for the specific patient.1-4
Check with your lab for their appropriate age- and sex-adjusted reference range.
This tool is for educational purposes only. It is not intended for use in diagnosis of any disease or condition or for the cure, mitigation, or treatment of any disease or condition. It does not replace a healthcare professional’s judgment or clinical diagnosis.
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While persistently low ALP is the biochemical hallmark of HPP, confirmatory information and testing can help support the diagnosis1,2:
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HPP is often overlooked because it resembles other musculoskeletal diseases in presentation and imaging. Delayed or missed diagnosis can lead to mismanagement, or worse, the use of potentially harmful therapies that add further complications.1,10,11
This list may not be exhaustive.
*Other treatments for osteoporosis (eg, RANK ligand [RANKL] inhibitors) may have adverse effects in adults with HPP.17
*Data collected from patients and caregivers via 2 survey instruments (web-based and phone interviews) to evaluate patient-reported symptomatology and burden of disease of HPP (N=125 adults).
Patient image is hypothetical.
QUICK QUESTION
The presence of persistently low age- and sex-adjusted ALP levels plus key signs and symptoms are sufficient to diagnose HPP.
References: 1. Rockman-Greenberg C. Pediatr Endocrinol Rev. 2013;10(suppl 2):380-388. 2. McKiernan FE, et al. J Bone Miner Res. 2014;29(7):1651-1660. doi: 10.1002/jbmr.2178 3. Colantonio DA, et al. Clin Chem. 2012;58(5):854-868. doi: 10.1373/clinchem.2011.177741 4. Bishop N, et al. Arch Dis Child. 2016;101(6):514-515. doi: 10.1136/archdischild-2015-309579 5. Whyte MP. Hypophosphatasia: nature’s window on alkaline phosphatase function in humans. In: Principles of Bone Biology. 3rd ed. Academic Press; 2008:1573-1598. 6. Mornet E, et al. Hypophosphatasia. In: Adam MP, Ardinger HH, Pagon RA, et al, eds. GeneReviews®. University of Washington; 2007. Accessed November 4, 2021. https://www.ncbi.nlm.nih.gov/books/NBK1150/ 7. Bianchi ML, et al. Osteoporos Int. 2020;31(8):1445-1460. doi: 10.1007/s00198-020-05345-9 8. Bianchi ML, et al. Osteoporos Int. 2015;26:2743-2757. doi: 10.1007/s00198-015-3272-1 9. Kishnani PS, et al. Mol Genet Metab. 2018;122(1-2):4-17. doi: 10.1016/j.ymgme.2017.07.010 10. Weber TJ, et al. Metabolism. 2016;65(10):1522-1530. doi: 10.1016/j.metabol.2016.07.006 11. Sutton RA, et al. J Bone Miner Res. 2012;27(5):987-994. doi: 10.1002/jbmr.1565 12. Mahagna H, et al. Int J Clin Pract. 2016;70(2):163-170. doi: 10.1111/ijcp.12760 13. Guañabens N, et al. J Bone Miner Res. 2014;29(4):929-934. 14. Braunstein N. Bone Rep. 2015;4:1-4. doi: 10.1016/j.bonr.2015.10.005 15. Shore R, et al. Pediatr Radiol. 2013;43:140-151. doi: 10.1007/s00247-012-2532-x 16.Shore R. Pediatr Radiol. 2013;43:152-172. doi:10.1007/s00247-012-2536-6 17. Shapiro JR, et al. J Bone Miner Res. 2017;32(10):1977-1980. doi: 10.1002/jbmr.3226.
