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25463 Bone Alkaline Phosphatase

Bone Alkaline Phosphatase
Test Code: BAP
Synonyms/Keywords
Bone-specific Alkaline phosphatase, Ostase
Useful For
Diagnosis and assessment of severity of metabolic bone disease including Paget disease, osteomalacia, postmenopausal Osteoporosis.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)​​
No​ ​Serum ​Serum Separator Tube (SST) ​Red Top Tube (RTT) ​1.0 mL ​0.65 mL ​0.5 mL
Collection Processing Instructions
Separate serum from the blood within 60 minutes of venipuncture. Specimen must be free of particulate matter including fibrin. Turbid specimens containing particulate matter should be centrifuged prior to analysis. The frozen specimens should be completely thawed thoroughly mixed and centrifuged before analysis. 1 freeze/thaw cycles has shown to have no qualitative difference in results. Specimen should be transported refrigerated (2 – 8 0C).
Specimen Stability Information
Specimen Type Temperature Time​​
Serum​ ​ ​ ​Ambient ​< 2 hours
​Refrigerate ​< 48 hours
​Frozen at -70 0C ​60 days
Rejection Criteria
Specimen not separated from cells within 60 minutes​
Gross hemolysis​
Interference
Gross hemolysis, icteria. Human anti-mouse or other heterophile antibodies may be present in patient specimens. Although the assay has been specifically formulated to minimize their effects on the assay, results from patients known to have these antibodies should be carefully evaluated.
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentati​​on
Marshfield​ Monday and ​Thursday ​Less than 2 hours ​Chemiluminescent Immunoassay/Beckman Coulter DXI
Test Information

Bone alkaline phosphatase (BAP) is the bone-specific isoform of alkaline phosphatase. A glycoprotein that is found on the surface of osteoblasts, BAP reflects the biosynthetic activity of these bone-forming cells. Serum levels of BAP are believed to reflect the metabolic status of osteoblasts. An accurate assessment of bone metabolism is critical for determining the severity of metabolic bone disease and responses to therapy. Measurement of serum levels of BAP has been shown to be useful in evaluating patients with Paget's disease, osteomalacia, primary hyperparathyroidism, renal osteodystrophy, osteoporosis and metastases to bone. BAP concentration is high in Paget disease and osteomalacia.

Osteoporosis is a metabolic bone disease characterized by low bone mass and abnormal bone microarchitecture. It can result from a number of clinical conditions including states of high bone turnover, endocrine disorders (primary and secondary hyperparathyroidism and thyrotoxicosis), osteomalacia, renal failure, gastrointestinal diseases, long-term corticosteroid therapy, multiple myeloma, and cancer metastatic to the bones.

Paget disease is another common metabolic bone disease caused by excessive rates of bone remodeling resulting in local lesions of abnormal bone matrix. These lesions can result in fractures or neurological involvement. Anti-resorptive therapies are used to restore the normal bone structure.

Reference Range Information
Performing Location Reference Ra​​nge ​
​Marshfield

​Males:
<2 yrs: 25-221 ug/L
2-9 yrs: 27-148 ug/L
10-13 yrs: 35-169 ug/L
14-17 yrs: 13-111 ug/L
Adult: <=20
 

​Females:
<2 yrs: 28-187 ug/L
2-9 yrs: 31-152 ug/L
10-13 yrs: 29-177 ug/L
14-17 yrs: 7-41 ug/L
Adult Pre-Menopause: <=14
Adult Post-Menopause: <=22

Interpretation

​​The BAP assay is not intended as a screening test for osteoporosis. The BAP results should be interpreted in light of the total clinical presentation of the patient, including: symptoms, clinical history, data from additional tests and other appropriate information.

Anti-resorptive therapies lower BAP from baseline measurements in Paget disease, osteomalacia, and osteoporosis. Several studies have shown that anti-resorptive therapies for management of osteoporosis patients should result in at least a 25% decrease in BAP within 3 to 6 months of initiating therapy. BAP also decreases following anti-resorptive therapy in Paget disease.

When used as a marker for monitoring purposes, it is important to determine the critical difference (or least significant change). The critical difference is defined as the difference between 2 determinations that may be considered to have clinical significance. The critical difference for this method was calculated to be 25% with a 95% confidence level. Therefore, changes in BAP concentrations that exceed 25% may be attributed to changes in bone remodeling.

Liver-derived alkaline phosphatase (ALP) has some cross-reactivity in this assay: 100 U/L of liver ALP activity gives a result of 2.5 g/L to 5.8 g/L. Accordingly, serum specimens with significant elevations of liver ALP activity may yield elevated results.

Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Commen​​ts
84080​ ​ ​1 ​ ​
Synonyms/Keywords
Bone-specific Alkaline phosphatase, Ostase
Ordering Applications
Ordering Application Description
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)​​
No​ ​Serum ​Serum Separator Tube (SST) ​Red Top Tube (RTT) ​1.0 mL ​0.65 mL ​0.5 mL
Collection Processing
Separate serum from the blood within 60 minutes of venipuncture. Specimen must be free of particulate matter including fibrin. Turbid specimens containing particulate matter should be centrifuged prior to analysis. The frozen specimens should be completely thawed thoroughly mixed and centrifuged before analysis. 1 freeze/thaw cycles has shown to have no qualitative difference in results. Specimen should be transported refrigerated (2 – 8 0C).
Specimen Stability Information
Specimen Type Temperature Time​​
Serum​ ​ ​ ​Ambient ​< 2 hours
​Refrigerate ​< 48 hours
​Frozen at -70 0C ​60 days
Rejection Criteria
Specimen not separated from cells within 60 minutes​
Gross hemolysis​
Interference
Gross hemolysis, icteria. Human anti-mouse or other heterophile antibodies may be present in patient specimens. Although the assay has been specifically formulated to minimize their effects on the assay, results from patients known to have these antibodies should be carefully evaluated.
Useful For
Diagnosis and assessment of severity of metabolic bone disease including Paget disease, osteomalacia, postmenopausal Osteoporosis.
Reference Range Information
Performing Location Reference Ra​​nge ​
​Marshfield

​Males:
<2 yrs: 25-221 ug/L
2-9 yrs: 27-148 ug/L
10-13 yrs: 35-169 ug/L
14-17 yrs: 13-111 ug/L
Adult: <=20
 

​Females:
<2 yrs: 28-187 ug/L
2-9 yrs: 31-152 ug/L
10-13 yrs: 29-177 ug/L
14-17 yrs: 7-41 ug/L
Adult Pre-Menopause: <=14
Adult Post-Menopause: <=22

Interpretation

​​The BAP assay is not intended as a screening test for osteoporosis. The BAP results should be interpreted in light of the total clinical presentation of the patient, including: symptoms, clinical history, data from additional tests and other appropriate information.

Anti-resorptive therapies lower BAP from baseline measurements in Paget disease, osteomalacia, and osteoporosis. Several studies have shown that anti-resorptive therapies for management of osteoporosis patients should result in at least a 25% decrease in BAP within 3 to 6 months of initiating therapy. BAP also decreases following anti-resorptive therapy in Paget disease.

When used as a marker for monitoring purposes, it is important to determine the critical difference (or least significant change). The critical difference is defined as the difference between 2 determinations that may be considered to have clinical significance. The critical difference for this method was calculated to be 25% with a 95% confidence level. Therefore, changes in BAP concentrations that exceed 25% may be attributed to changes in bone remodeling.

Liver-derived alkaline phosphatase (ALP) has some cross-reactivity in this assay: 100 U/L of liver ALP activity gives a result of 2.5 g/L to 5.8 g/L. Accordingly, serum specimens with significant elevations of liver ALP activity may yield elevated results.

For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentati​​on
Marshfield​ Monday and ​Thursday ​Less than 2 hours ​Chemiluminescent Immunoassay/Beckman Coulter DXI
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Commen​​ts
84080​ ​ ​1 ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.