Clinical Utility of a Wheat-Germ Precipitation Assay for Determination of Bone Alkaline Phosphatase Concentrations in Patients with Different Metabolic Bone Diseases

Summary: Bone alkaline phosphatase was evaluated by wheat-germ lectin precipitation in several clinical condi-tions. The study included 33 premenopausal healthy women, 46 postmenopausal apparently healthy women, 19 growing children, 24 patients with Pagefs disease, 31 patients with primary hyperparathyroidism and 66 patients with hepatobiliary diseases. In postmenopausal women the mean T score (i. e.: the number of SD below or above the mean for premenopausal women) was 2.6 ± 1.3 (SD) for bone alkaline phosphatase and 1.61 ± 1.21 for total alkaline phosphatase (p < 0.001). The T score for bone alkaline phosphatase provided a better discrimination from normals for both Pagefs disease (22.1 ± 27.8 versus 12.8 ± 16 p < 0.001) and primary hyperparathyroidism (8.2 ± 4.3 versus 4.6 ± 3.7 p < 0.005 for bone alkaline phosphatase and total alkaline phosphatase respectively). After treatment with intravenous bisphosphonate the percent decrease of bone alkaline phosphatase was larger than that of total alkaline phosphatase both in patients with Pagefs disease (-46 % versus-72 % p < 0.01) and in patients with primary hyperparathyroidism (—21 % versus —47 % p < 0.02) and an estimate of the precision (Δ mean/SD of the Δ mean) for bone alkaline phosphatase was 1.9—3.7 times higher than that of total alkaline phosphatase. In twelve osteoporotic patients treated for six months with oral alendronate the decrease in bone turnover was detected with significantly higher precision with bone alkaline phosphatase than with total alkalin