What is Alkaline Phosphatase?
Alkaline phosphatase (ALP) is an enzyme found primarily in the liver and bones. It helps break down proteins and plays an essential role in bone mineralization and bile transport.
When a bone heals after a fracture or during periods of growth, bones produce more ALP. That same enzyme is also present in bile ducts in the liver. Because ALP originates primarily from these two tissues, shifts in ALP levels often reflect either increased bone activity or problems with bile movement.
Why Does ALP Matter?
- Supports strong bone development and repair
- Support bile production, which is necessary for eliminating waste and absorbing fat-soluble vitamins
- Protect gut integrity and reduce inflammatory signaling by helping regulate pro-inflammatory molecules
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How to Interpret ALP
(Ranges may vary slightly by lab)
Standard reference ranges represent the middle 95% of healthy individuals but don’t necessarily reflect levels associated with longevity. Optimal ranges are derived from clinical guidelines, peer-reviewed research, and real-world outcomes data, with an emphasis on levels associated with peak functioning and reduced disease risk.
Benefits of Optimizing ALP
- Improved liver health and detoxification
- Reduced inflammation and risk of chronic disease1
- Reduced risk of metabolic syndrome2
- Reduced risk of sarcopenia (muscle loss)3
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Low ALP Levels
Low levels ALP levels are uncommon, but may be associated with nutrient deficiencies or rare genetic conditions.
Symptoms:
- Fatigue
- Bone pain
- Muscle weakness
- Frequent fractures
- Dental problems
Causes:
- Nutritional deficiencies (e.g., Vitamin B12, Magnesium, Zinc)
- Hypothyroidism
- Certain medications (e.g., oral contraceptives)
- Wilson’s disease
- Severe anemias
- Celiac disease
- Post-cardiac surgery
Healthspan impacts:
High ALP Levels
High ALP levels can reflect bile duct obstruction, liver disease, or increased bone turnover.
Symptoms:
- Fatigue
- Nausea
- Abdominal pain (often on the right side)
- Jaundice (yellowing of the skin and eyes)
- Dark urine
- Bone pain
- Light-colored stools
Causes:
- Certain medications (e.g., antibiotics; cardiovascular drugs; NSAIDs; hormonal treatments)
- Diabetes
- Viral hepatitis
- Autoimmune disorders
- Bone disorder
- Pregnancy
- Celiac disease or inflammatory bowel disease (IBD)
- Liver problems
Healthspan impacts:
How Hone Treats Out of Range ALP
Your Hone physician will evaluate ALP levels from your blood test alongside albumin, globulin, liver enzymes, kidney markers and hydration status to create a personalized treatment protocol.
- Levothyroxine – to treat hypothyroidism, a common cause of high ALP levels
- Cinacalcet*- to reduce high ALP levels in those with chronic kidney disease*
- Prescription adjustments – if elevated ALP levels are caused by certain medications
- Surgery* – to remove gallstones or liver tumors
*Your Hone Physician does not prescribe these treatments but will recommend further evaluation and help coordinate care with your primary care provider when medical treatment is indicated.
- Limit alcohol
- Get regular exercise
- Reduce intake of fatty foods and processed foods to reduce liver stress
- Increase zinc- (yogurt, pumpkin seeds, poultry) and magnesium-rich foods (almonds, potatoes, chia seeds) to boost low ALP levels
- Address Vitamin D status when bone-related ALP is elevated
Lung, B. E., et al. (2023). Alkaline Phosphatase is an Independent Risk Factor for Periprosthetic Fractures in Total Joint Arthroplasty. JAAOS Global Research & Reviews.
↑Krishnamurthy, V.R., et al. (2011). Associations of Serum Alkaline Phosphatase with Metabolic Syndrome and Mortality. The American Journal of Medicine.
↑Asano, K., et al. (2025). Serum alkaline phosphatase elevation as a preoperative sarcopenic biomarker in digestive cancer: A retrospective cohort study. Supportive Care in Cancer.
↑Park, S. Y., et al. (2018). Lower expression of endogenous intestinal alkaline phosphatase may predict worse prognosis in patients with Crohn’s disease. BMC Gastroenterology.
↑Shu, Y., et al. (2024). Causal effects from inflammatory bowel disease on liver function and disease: A two-sample Mendelian randomization study. Frontiers in Medicine.
↑Sinha, P., et al. (2022). Dental manifestations in adult hypophosphatasia and their correlation with biomarkers. JIMD Reports.
↑Lung, B.E., et al. (2023). Alkaline Phosphatase is an Independent Risk Factor for Periprosthetic Fractures in Total Joint Arthroplasty. JAAOS Global Research & Reviews.
↑Liu, K., et al. (2022). Elevated Levels of Serum Alkaline Phosphatase are Associated with Increased Risk of Cardiovascular Disease: A Prospective Cohort Study. Journal of Atherosclerosis and Thrombosis.
↑Kausik, K.R., et al (2019). Abstract 12948: ALP Levels Predict Adverse Cardiovascular Outcomes and Cognitive Impairment in High Risk Patients. Circulation.
↑Chen, X., et al. (2025). The role of taurine in bone metabolism. IScience.
↑Al Garea MH, et al (2023). Vitamin C as a potential ameliorating agent against hepatotoxicity among alcoholic abusers. Eur Rev Med Pharmacol Sci.
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Reviewed for Accuracy by Our Medical Review Board
This biomarker information has been reviewed by a member of Hone’s medical review board. As part of the medical review team, physicians fact-check this content against the latest research and their own experience treating their patients.
Ashley Winter, M.D., is a board-certified urogynecologist trained at Weill Cornell and Cleveland Clinic. She specializes in female and male sexual dysfunction, urinary issues, genital pain, and hormone therapy.
James Staheli, D.O., is the Medical Director for Broad Health, Hone Health’s affiliated medical practice and a family medicine doctor in Atlanta, Georgia.
