DEAR DR. ROACH: For several years, when I have had blood drawn it has shown an elevation in the alkaline phosphatase. It has been as high as 377 in recent tests. I have had the test to see if it was from the liver, but it was all right. I recently had a bone scan, and the doctor suspects Paget’s disease and is referring me to a bone oncologist. Do you have any comments in regard to this? — D.C.A.
ANSWER: Alkaline phosphatase is an enzyme that, when found in the blood, usually comes from the liver. Conditions such as gallstones or others that affect bile flow are the most likely to increase the level in the blood. However, alkaline phosphatase also may come from the bone, and in this case, Paget’s disease is the most likely cause. Your doctor may have determined where the alkaline phosphatase is coming from by ordering a special isoenzyme blood test. The bone scan is usually diagnostic for Paget’s.
Paget’s disease is thought to result from abnormal osteoclasts, the cells that normally remodel bone. The osteoclasts break down bone, and osteoblasts build it back up again. Bone needs to be replaced over time to repair any microscopic cracks that have formed. Without normal bone turnover, the bones become brittle.
In Paget’s disease, the bone remodeling in one or more particular areas is excessive, causing bone buildup. The most common sites are the skull, spine, pelvis and leg bones. Paget’s disease is very effectively treated with medications such as zoledronic acid (Reclast or Zometa). Not all people with Paget’s need treatment; however, a high alkaline phosphatase level usually is a reason to treat.
DEAR DR. ROACH: I’m a 70-year-old man in good health. I exercise daily and eat wholesome foods. I now realize that my sexual activity is better in the mornings. On occasion, I get up, take Viagra and go for a brisk walk, have breakfast and go back to bed. Is the testosterone level higher in the mornings? — Anon.
ANSWER: Yes, testosterone levels are higher for both men and women in the mornings. Even younger men often notice this. Also, Viagra works much better if it is taken on an empty stomach and given one to two hours to work.
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