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Laboratory: Clinical Biochemistry  (SENDOUTS)
Test Name:
Test Code: MISC
Clinical Information:
Test Indications: Bone Turnover / Formation Marker - Aid in managing patients with metabolic bone disease.
- Monitor response to antiresorptive therapy in postmenopausal women and individuals with osteoporosis  Note: Does not replace bone mineral density (BMD) screening to diagnose osteoporosis.
This test is no longer recommended in the diagnosis or monitoring of Paget’s disease (see Guidelines) due to high assay cross-reactivity with liver ALP.
Test Approval Requirements: Clinical Biochemist Approval Required
Collection Devices:
Stability 2 days refrigerated, 2 months frozen
Specimen Required:

Serum: 1.0 mL

Special Processing: Separate serum from cells within 45-60 min of collection.
Specimen Stability:
Ambient: 1 day (separated from cells)
Refrigerated: 2 days
Frozen: 2 months at -20 C
Serum: 1.0 mL

Shipping & Storage: Aliquot, store and send frozen to HSC clinical Chemistry – MS5.
Testing Laboratory (MB): Referred Out
Referred Out Location: Specimen referred from HSC-MS5 to:
In-Common Laboratories
57 Gervais Drive
North York, Ontario
M3C 1Z2
Telephone: (416)422-3000
Testing location: Mount Sinai, Toronto, ON
Reference Values:
Reference Intervals: 
Male: 0-20 ug/L
Female (pre-menopausal): ≤14 ug/L
Female (post-menopausal): ≤22 ug/L
Method of Analysis: Chemiluminescent Immunoassay (CLIA)
Within 3 Weeks
Clinical Biochemist Approval Required
See Also:
More Information:
Interpretation & Assay Interferences: Up to 20% cross-reactivity of antibodies to liver ALP with bone ALP.
Do not use hemolyzed samples as red cell enzymes may interfere with reaction. Anticoagulants, such as EDTA, citrate and oxalate inhibit ALP activity
Frederick R. Singer, Henry G. Bone, III, David J. Hosking, Kenneth W. Lyles, Mohammad Hassan Murad, Ian R. Reid, Ethel S. Siris, Paget's Disease of Bone: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 99, Issue 12, December 2014, Pages 4408–4422
Ralston, S.H., Corral-Gudino, L., Cooper, C., Francis, R.M., Fraser, W.D., Gennari, L., Guañabens, N., Javaid, M.K., Layfield, R., O'Neill, T.W., Russell, R.G.G., Stone, M.D., Simpson, K., Wilkinson, D., Wills, R., Zillikens, M.C. and Tuck, S.P. (2019), Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline. J Bone Miner Res, 34: 579-604 e3657