University of Oulu

Freja Pontán, Helena Hauta-alus, Saara Valkama, Jenni Rosendahl, Maria Enlund-Cerullo, Sture Andersson, Outi Mäkitie, Elisa Holmlund-Suila, Alkaline Phosphatase and Hyperphosphatasemia in Vitamin D Trial in Healthy Infants and Toddlers, The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 10, October 2023, Pages e1082–e1091,

Alkaline phosphatase and hyperphosphatasemia in vitamin D trial in healthy infants and toddlers

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Author: Pontán, Freja1; Hauta-alus, Helena1,2,3,4; Valkama, Saara1,2;
Organizations: 1Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
2Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
3Finnish Institute for Health and Welfare (THL), Helsinki, Finland
4PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
5Folkhälsan Institute of Genetics, Helsinki, Finland
6Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
Format: article
Version: accepted version
Access: embargoed
Persistent link:
Language: English
Published: Endocrine society, 2023
Publish Date: 2024-04-17


Context: Childhood hyperphosphatasemia is usually transient and may be associated with infections. It remains less well known how hyperphosphatasemia is related to growth and bone mineralization.

Objective: We explored alkaline phosphatase (ALP) concentrations and prevalence of hyperphosphatasemia, and their association with vitamin D, growth, infections, and bone parameters in healthy children.

Methods: The study was a secondary analysis of a vitamin D intervention trial. Participants received vitamin D₃ 10 or 30 µg daily from age 2 weeks to 2 years. Children with data on ALP at 12 and/or 24 months (n = 813, girls 51.9%) were included. Anthropometrics and bone parameters were measured at 12 and 24 months. Infections were recorded prospectively by the parents.

Results: Boys had higher ALP than girls at 12 months (median [IQR] 287 [241‐345] U/L vs 266 [218‐341] U/L; P = .02). At 24 months concentrations were lower than at 12 months (240 [202‐284]; P < .001) but without sex difference. The prevalence of hyperphosphatasemia (ALP > 1000 U/L) at 12 months was 5.3% and at 24 months 0.6%. Body size, growth rate, and bone mineral content associated positively with ALP, while vitamin D intervention had no effect. Infants with hyperphosphatasemia were smaller than infants with ALP ≤ 1000 U/L. Hyperphosphatasemia was not associated with previous infections.

Conclusions: Approximately 5% of infants had hyperphosphatasemia at 12 months, but <1% at 24 months. ALP concentrations and hyperphosphatasemia were associated with sex, anthropometry, and bone mineralization. Infections did not contribute to hyperphosphatasemia.

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Series: Journal of clinical endocrinology & metabolism
ISSN: 0021-972X
ISSN-E: 1945-7197
ISSN-L: 0021-972X
Volume: 108
Issue: 10
Pages: e1082 - e1091
DOI: 10.1210/clinem/dgad208
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This study was funded by Lastentautien Tutkimussäätiö, the Academy of Finland, the Sigrid Jusélius Foundation, Folkhälsanin Tutkimussäätiö, the Novo Nordisk Foundation, A Special Governmental Subsidy for Clinical Research, Finska läkaresällskapet, Stiftelsen Dorothea Olivia, Karl Walter och Jarl Walter Perkléns minne, Juho Vainio Foundation, and the Päivikki and Sakari Sohlberg Foundation.
Copyright information: © The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved.