Causes of elevated bone-specific alkaline phosphatase

Severe hyperparathyroidism

Hyperthyroidism

Paget disease of bone

Metastatic carcinoma to bone

Osteomalacia

Severe 25-hydroxyvitamin D deficiency (<10 ng/mL)

Recent large bone fracture

Immobilization/space travel

Treatment with teriparatide or 1-84 parathyroid hormone

High bone turnover osteoporosis

Source: Miller PD. Unrecognized and unappreciated secondary causes of osteoporosis. Endocrinol Metab Clin North Am 2012; 41:613.

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