Bone-specific alkaline phosphatase as a marker of bone formation: Clinical and imaging correlates

doi:10.5493/wjem.121518

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World Journal of Experimental Medicine

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2220-315x

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Exp Med. Sep 20, 2026; 16(3): 121518
Published online Sep 20, 2026. doi: 10.5493/wjem.121518

Bone-specific alkaline phosphatase as a marker of bone formation: Clinical and imaging correlates

Pooja Jayaraman Thirunavukkarasu, Arunagiri Gunasekar, Naveen Jeyaraman, Arulkumar Nallakumarasamy, Viji Devanand, Sanjeevi Bharadwaj, Madhan Jeyaraman

Pooja Jayaraman Thirunavukkarasu, Arunagiri Gunasekar, Department of Orthopaedics, Government Medical College and Hospital, Thiruvallur 602001, Tamil Nadu, India

Naveen Jeyaraman, Madhan Jeyaraman, Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India

Naveen Jeyaraman, Arulkumar Nallakumarasamy, Madhan Jeyaraman, Department of Regenerative Medicine, Agathisha Institute of Stemcell and Regenerative Medicine (AISRM), Chennai 600030, Tamil Nadu, India

Arulkumar Nallakumarasamy, Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal 609602, Puducherry, India

Viji Devanand, Department of Physiology, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai 600044, Tamil Nadu, India

Sanjeevi Bharadwaj, Department of Trauma and Orthopaedics, Wye Valley National Health Service Trust, Hereford HR1 2BN, Herefordshire, United Kingdom

Author contributions: Jeyaraman M, Bharadwaj S, and Jeyaraman N designed the research; Thirunavukkarasu PJ, Gunasekar A, Jeyaraman N, Nallakumarasamy A, Devanand V, and Bharadwaj S analyzed the articles for performing review and wrote the manuscript; Jeyaraman M finalized the manuscript.

AI contribution statement: No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions.

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

Corresponding author: Madhan Jeyaraman, MD, PhD, Researcher, Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Velappanchavadi, Chennai 600077, Tamil Nadu, India. madhanjeyaraman@gmail.com

Received: March 26, 2026
Revised: May 26, 2026
Accepted: June 17, 2026
Published online: September 20, 2026
Processing time: 178 Days and 8.9 Hours

Core Tip

Core Tip: Bone-specific alkaline phosphatase (BSAP) is a good indicator of osteoblastic bone formation, released by osteoblasts as the matrix matures and becomes mineralized. In contrast to imaging, BSAP reflects metabolic activity, increasing early with anabolic therapies and helping to differentiate bone disorders, including Paget’s disease, hypophosphatasia and chronic kidney disease-related bone disease. However, due to the difficulties in standardization and in having norm values, BSAP’s combination with imaging and artificial intelligence models holds the promise of a more accurate and personalized approach to skeletal health.