{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:46:35Z","timestamp":1791909995838,"version":"4.3.4"},"reference-count":61,"publisher":"Walter de Gruyter GmbH","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This review summarises the clinical relevance of alkaline phosphatase (ALP) in paediatrics, placing emphasis on its biochemical heterogeneity, age-dependent physiology and diagnostic value in bone and hepatobiliary disorders. ALP is a group of membrane-bound enzymes, predominantly represented in serum by tissue-nonspecific alkaline phosphatase, with major contributions from bones and the liver. In children, interpretation of ALP concentration is complicated due to marked physiological variation occurring in growth and puberty, as well as by method-dependent differences in laboratory reference ranges. An elevated ALP activity may reflect normal growth; however, it may also result from benign transient hyperphosphatasaemia, rickets, fibrous dysplasia, juvenile Paget\u2019s disease, metabolic bone disease of prematurity or cholestatic liver disease. Low ALP activity, although less common, may be associated with hypophosphatasia, malnutrition, micronutrient deficiencies or medication effects. ALP should, therefore, be interpreted in the context of age, clinical presentation and supplementary findings of biochemical tests and diagnostic imaging.<\/jats:p>","DOI":"10.1515\/jpem-2026-0400","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:55:55Z","timestamp":1791906955000},"source":"Crossref","is-referenced-by-count":0,"title":["Alkaline phosphatase in paediatric practice: a practical approach with a proposed diagnostic algorithm"],"prefix":"10.1515","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1955-7865","authenticated-orcid":false,"given":"Jakub","family":"Parys","sequence":"first","affiliation":[{"name":"Department of Paediatrics , Neonatal Pathology and Metabolic Bone Diseases, Medical University of Lodz , Lodz , Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9483-4211","authenticated-orcid":false,"given":"Jakub Krzysztof","family":"Nowicki","sequence":"additional","affiliation":[{"name":"Department of Paediatrics , Neonatal Pathology and Metabolic Bone Diseases, Medical University of Lodz , Lodz , Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5346-5229","authenticated-orcid":false,"given":"El\u017cbieta","family":"Jakubowska-Pietkiewicz","sequence":"additional","affiliation":[{"name":"Department of Paediatrics , Neonatal Pathology and Metabolic Bone Diseases, Medical University of Lodz , Lodz , Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"2026101315554880984_j_jpem-2026-0400_ref_001","doi-asserted-by":"crossref","unstructured":"Vimalraj, S. Alkaline phosphatase: structure, expression and its function in bone mineralization. Gene 2020;754:144855. https:\/\/doi.org\/10.1016\/j.gene.2020.144855.","DOI":"10.1016\/j.gene.2020.144855"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_002","doi-asserted-by":"crossref","unstructured":"Makris, K, Mousa, C, Cavalier, E. Alkaline phosphatases: biochemistry, functions, and measurement. Calcif Tissue Int 2022;112:233\u201342. https:\/\/doi.org\/10.1007\/s00223-022-01048-x.","DOI":"10.1007\/s00223-022-01048-x"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_003","doi-asserted-by":"crossref","unstructured":"Sharma, U, Pal, D, Prasad, R. Alkaline phosphatase: an overview. Indian J Clin Biochem 2014;29:269\u201378. https:\/\/doi.org\/10.1007\/s12291-013-0408-y.","DOI":"10.1007\/s12291-013-0408-y"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_004","doi-asserted-by":"crossref","unstructured":"Mill\u00e1n, JL. Alkaline phosphatases. Purinergic Signal 2006;2:335\u201341. https:\/\/doi.org\/10.1007\/s11302-005-5435-6.","DOI":"10.1007\/s11302-005-5435-6"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_005","doi-asserted-by":"crossref","unstructured":"Cannalire, G, Pilloni, S, Esposito, S, Biasucci, G, Di Franco, A, Street, ME. Alkaline phosphatase in clinical practice in childhood: focus on rickets. Front Endocrinol 2023;14:1111445. https:\/\/doi.org\/10.3389\/fendo.2023.1111445.","DOI":"10.3389\/fendo.2023.1111445"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_006","doi-asserted-by":"crossref","unstructured":"Van Hoof, VO, De Broe, ME. Interpretation and clinical significance of alkaline phosphatase isoenzyme patterns. Crit Rev Clin Lab Sci 1994;31:197\u2013293. https:\/\/doi.org\/10.3109\/10408369409084677.","DOI":"10.3109\/10408369409084677"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_007","doi-asserted-by":"crossref","unstructured":"Nizet, A, Cavalier, E, Stenvinkel, P, Haarhaus, M, Magnusson, P. Bone alkaline phosphatase: an important biomarker in chronic kidney disease\u00a0\u2013\u00a0mineral and bone disorder. Clin Chim Acta 2020;501:198\u2013206. https:\/\/doi.org\/10.1016\/j.cca.2019.11.012.","DOI":"10.1016\/j.cca.2019.11.012"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_008","doi-asserted-by":"crossref","unstructured":"Sardiwal, S, Magnusson, P, Goldsmith, DJA, Lamb, EJ. Bone alkaline phosphatase in CKD-mineral bone disorder. Am J Kidney Dis 2013;62:810\u201322. https:\/\/doi.org\/10.1053\/j.ajkd.2013.02.366.","DOI":"10.1053\/j.ajkd.2013.02.366"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_009","doi-asserted-by":"crossref","unstructured":"Minisola, S, Cipriani, C, Colangelo, L, Labbadia, G, Pepe, J, Magnusson, P. Diagnostic approach to abnormal alkaline phosphatase value. 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The bone markers sclerostin, osteoprotegerin, and bone-specific alkaline phosphatase are related to insulin resistance in children and adolescents, independent of their association with growth and obesity. Horm Res Paediatr 2019;91:1\u20138. https:\/\/doi.org\/10.1159\/000497113.","DOI":"10.1159\/000497113"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_019","doi-asserted-by":"crossref","unstructured":"Kempf, E, Vogel, M, Vogel, T, Kratzsch, J, Landgraf, K, K\u00fchnapfel, A, et al.. Dynamic alterations in linear growth and endocrine parameters in children with obesity and height reference values. EClinicalMedicine 2021;37. https:\/\/doi.org\/10.1016\/j.eclinm.2021.100977.","DOI":"10.1016\/j.eclinm.2021.100977"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_020","doi-asserted-by":"crossref","unstructured":"van der Eerden, BC, van Til, NP, Brinkmann, AO, Lowik, CWGM, Wit, JM, Karperien, M. 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Benign transient hyperphosphatasemia in adults: case report and literature review. HCA Healthc J Med 2026;7:11.","DOI":"10.36518\/2689-0216.1835"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_026","doi-asserted-by":"crossref","unstructured":"Sakurai, Y, Higashiguchi, T. Transient hyperphosphatasemia: possible association with pediatric acute respiratory infection. Pediatr Investig 2021;5:94\u20138. https:\/\/doi.org\/10.1002\/ped4.12265.","DOI":"10.1002\/ped4.12265"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_027","doi-asserted-by":"crossref","unstructured":"Shkalim Zemer, V, Hoshen, M, Levinsky, Y, Richenberg, Y, Yosef, N, Oberman, B, et al.. Benign transient hyperphosphatasemia in infants and children: a retrospective database study. 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X-linked hypophosphatemic rickets: multisystemic disorder in children requiring multidisciplinary management. Front Endocrinol 2021;12:688309. https:\/\/doi.org\/10.3389\/fendo.2021.688309.","DOI":"10.3389\/fendo.2021.688309"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_036","doi-asserted-by":"crossref","unstructured":"Haffner, D, Emma, F, Eastwood, DM, Biosse Duplan, M, Bacchetta, J, Schnabel, D, et al.. Clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia. Nat Rev Nephrol 2019;15:435\u201355. https:\/\/doi.org\/10.1038\/s41581-019-0152-5.","DOI":"10.1038\/s41581-019-0152-5"},{"key":"2026101315554880984_j_jpem-2026-0400_ref_037","doi-asserted-by":"crossref","unstructured":"Michigami, T, Kang, HG, Namba, N, Ito, N, Kubota, T, Shintani, A, et al.. Burosumab treatment of X-linked hypophosphatemia patients: interim analysis of the SUNFLOWER longitudinal, observational cohort study. 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