The use of alkaline phosphatase as a bone turnover marker after spinal cord injury: A scoping review of human and animal studies

The Journal of Spinal Cord Medicine, 2023 · DOI: 10.1080/10790268.2021.1977905 · Published: March 1, 2023

Spinal Cord Injury Bioinformatics Musculoskeletal Medicine

Simple Explanation

This review explores how alkaline phosphatase (ALP) and bone-specific alkaline phosphatase (B-ALP) are used in spinal cord injury (SCI) studies with humans and animals. The aim is to find ways to improve research using these markers for bone health after SCI. Researchers are encouraged to measure B-ALP rather than total ALP in future studies.

Study Duration

Not specified

Participants

Human studies: 2,068 participants. Animal studies: Not specified

Evidence Level

Scoping review

Key Findings

1
Evidence regarding changes in ALP levels in individuals with SCI compared to controls is conflicting.
2
B-ALP seemed to increase after teriparatide and decrease after denosumab.
3
The effects of exercise on ALP and B-ALP levels are heterogeneous and depend on the type of exercise performed.

Research Summary

The review highlights the potential utility of ALP and B-ALP in assessing changes in bone turnover in humans with SCI, but evidence in animal models is less compelling. The association between ALP and comorbidities like chronic kidney disease, diabetes, or adipose infiltration in the liver should be further investigated in the SCI population. Current evidence in animal models does not support using ALP or B-ALP to evaluate bone status in rodent models of SCI.

Practical Implications

Bone formation assessment

B-ALP may be a useful marker for assessing bone formation, particularly in response to pharmacological interventions, but clinical decisions should not rely solely on B-ALP levels.

Further Research

Further research is needed to evaluate the utility of B-ALP as a marker of bone formation responsive to non-pharmacological interventions and to understand its levels in the presence of conditions like diabetes or chronic kidney disease.

Clinical trials

Measurement of B-ALP is advocated when assessing bone status after pharmacologic therapies in the SCI population.

Study Limitations

1
Only 24 of 42 human studies and six of eleven studies on animal models measured the bone-specific isoform of ALP.
2
Most of the human studies recruited individuals with both paraplegia and tetraplegia, limiting the ability to determine if B-ALP responses vary by lesion level.
3
14 human studies and two animal studies did not describe the procedures used to measure ALP levels.

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