Bone alkaline phosphatase in Paget's disease.

The measurement of bone proteins and peptides and their derived products has been very useful in the diagnosis and management of patients with skeletal disease. This group of assays includes alkaline phosphatase (AP) and bone Gla protein (BGP). We here describe the comparison of a new immunoassay that is specific for bone alkaline phosphatase (BAP) to measurements of total alkaline phosphatase (TAP) and BGP in Paget's disease. In our studies, we demonstrated that BAP was increased in the serum of patients with Paget's disease. Comparisons with the other measurements revealed that BAP correlated better with total AP (r = 0.92) than with BGP (r = 0.51); the lowest correlation occurred between BGP and total AP (r = 0.26). In patients with liver disease, the BAP was indistinguishable from normal whereas the TAP was elevated. These studies indicate that BAP assesses different aspects of bone cell function than BGP in Paget's disease. This discordancy also exists between BGP and total serum AP activity. BAP measurements by immunoassay offer a novel method of assessing skeletal status. Thus, the information that measurement of different bone-specific proteins provides should be separately useful in assessing the skeleton for a variety of metabolic bone diseases.