Alkaline phosphatase and acid phosphatase in health and disease - A systematic review

Bone growth and remodelling are the outcomes of osteoblastic and osteoclastic cell activity which may be assessed by the biochemical markers. Alkaline phosphatase (ALP) is a hydrolase enzyme associated with osteoblastic activity, and in contrast, acid phosphatase (AP) is associated with osteoclastic activity and is widely used as a prognostic and diagnostic marker for bone-related lesions. This systematic review aims to analyse the applicability of alkaline phosphatase and acid phosphatase as diagnostic and prognostic markers in various pathological conditions. A systematic review was conducted using PRISMA guidelines. Electronic databases such as PubMed and Cochrane were searched for relevant articles with the keywords ALKALINE PHOSPHATASE and ACID PHOSPHATASE from 1990 to 2023. Studies on alkaline phosphatase and acid phosphatase levels in bone lesions and chronic kidney disease were included. After thorough scrutiny, 55 articles fulfilled our inclusion criteria and exclusion criteria. On tabulating the extracted data, 15% of studies stated that pre-operative serum ALP levels differ in fibro-osseous lesions with fibrous dysplasia having the highest level. 11% of studies used a centrifugal autoanalyser and 10% of studies used colorimetry and ELISA for detecting serum ALP. This systematic review reveals the most widely used method of detection of ALP and AP in pathologic situations and also highlights its diagnostic and prognostic significance.