First-line laboratory finding in Paget's disease is an elevation of which enzyme?

First-line laboratory finding in Paget's disease is an elevation of which enzyme?

• A. Elevated ALP
• B. Elevated calcium
• C. Low ALP
• D. Low calcium

Answer: (A)

Paget's disease causes rapid, disorganized bone remodeling with markedly increased osteoblastic activity. Alkaline phosphatase is a marker of bone formation, so it rises when bone turnover is up. This makes elevated alkaline phosphatase the most consistent and early laboratory finding. Calcium and phosphate usually stay normal because systemic calcium balance is preserved, so you wouldn’t expect high calcium or low alkaline phosphatase in this setting. Low ALP would suggest reduced bone formation, which isn’t the process here.

Paget's disease causes rapid, disorganized bone remodeling with markedly increased osteoblastic activity. Alkaline phosphatase is a marker of bone formation, so it rises when bone turnover is up. This makes elevated alkaline phosphatase the most consistent and early laboratory finding. Calcium and phosphate usually stay normal because systemic calcium balance is preserved, so you wouldn’t expect high calcium or low alkaline phosphatase in this setting. Low ALP would suggest reduced bone formation, which isn’t the process here.