Abstract
A 60-year-old man who took a blood test for suspected gout was referred to our hospital because the data showed a high serum level of alkaline phosphatase (ALP) at 2059 U/l. The bone-specific ALP (BAP) level was 318 U/l and the serum NTX level was also high, exceeding 80nmol BCE/L. Bone scintigraphy demonstrated abnormal accumulation in many bones, and the corresponding X-ray images demonstrated bone resorption and bone formation in the same locations. The left humerus in particular was bent and enlarged.
Alendronate was started at 70mg twice a week, and the ALP level declined to 186 U/l and BAP to 17.6nmol BCE/L 7months later. Because laboratory data were stable at 11months, we reduced the dose of alendronate to 35mg twice a week. Restoration of the bone cortex and trabecular bone was observed by X-ray one year later.
In the present case, safe and effective control was obtained using only half the dosage of alendronate recommended by the American FDA. We intend to adjust the dosage of alendronate according to symptoms and changes in laboratory data.
