International E-publication: Publish Projects, Dissertation, Theses, Books, Souvenir, Conference Proceeding with ISBN.  International E-Bulletin: Information/News regarding: Academics and Research

Evaluation of Serum Alkaline Phosphatase as a Biomarker of Healing Process Progression of Simple Diaphyseal Fractures in Adult Patients

Author Affiliations

  • 11Department of Orthopaedics, King George's Medical University, Lucknow-226003, UP, INDIA
  • 2 Department of Biochemistry, King George's Medical University, Lucknow-226003, UP, INDIA

Int. Res. J. Biological Sci., Volume 2, Issue (2), Pages 40-43, February,10 (2013)


In day to day practice, progression of bone healing is assessed mainly by clinico-radiological parameters. Furthermore, clinicians are unable to identify the delayed and nonunions early, and even advanced imaging techniques may not be helpful in these cases; hereby increasing the suffering period of the patients. Serum biomarkers, such as alkaline phosphatase (ALP) suggestive of bone formation, may be clinically useful in evaluating the progress of fracture healing. Changes in serum ALP levels were noted at definitive intervals in 95 adult patients (enrolled as per inclusion/exclusion criterion) with simple traumatic diaphyseal fractures of both bones of leg. Regular follow up of these patients was done till either bone union was completed or maximum up to the end of 09 month. The changes in serum ALP levels were recorded and correlated with the clinico-radiological progression of fracture healing in these patients.Depending on the clinico-radiological parameters of progression of fracture healing, all 95 patients were allocated into 02 groups by the end of active follow up; Group A (n = 69): clinico-radiological union achieved before or by the end of 06 months; and Group B (n = 26): clinico-radiological union not completed by the end of 06 months. The Group B was further subdivided into B1 (n= 18): clinico-radiological healing not completed by 06 months but completed by the end of 09 months; and B2 (n= 08): clinico-radiological healing not achieved even by the end of 09 months - Non-union. At the time of admission, mean serum ALP levels remained within normal limits in all included patients. Mean serum ALP levels followed the same pattern in group A and B, reaching a maximum level at post trauma 3rd week. But the mean levels of serum ALPat every selected interval was significantly higher in group A than group B. In Group A, serum ALP levels returned to normal values by complete union achieved (mean healing occurred at 19.2 weeks), where as in group B values remained elevated even by the end of 06 months (mean time of union 28.5 weeks). In Group B2, mean serum ALP level remained within normal limits throughout the followup. So, the determination of serum ALP levels during fracture healing could be an additional tool in predicting fractures at risk of delayed / nonunion of simple diaphyseal fractures, aiding the clinician to prefer the early appropriate intervention at appropriate period.


  1. Davis B.J., Robert P.J., Moocroft C.I., Brown M.F., Thomas P.B.M. and Wade R.H., Reliability of radiographs in defining union of internally fixed fractures, Injury, 35(6), 557-561 (2005)
  2. Meller Y., Kestenbaum R.S. and Mozes M., Mineral and endocrine metabolism during fracture healing in dogs, Clin Orthop,187, 289-295 (1984)
  3. Wade R. and Richardson J., Outcome in fracture healing – a review, Injury, 32(2), 109-114 (2001)
  4. Hammer R., Hammerby S. and Lindholm B., Accuracy of radiological assessment of tibial shaft fractures in humans, Clin Orth Res.,19(9), 233-238 (1985)
  5. Mc Closkey E.V., Spector T.D., Eyres K.S., Fern E.D., O’Rourke N., Vasikaran S. and Kanis J.A., The assessment of vertebral deformity: a method for use in population studies and clinical trials, Osteoporosis International,3(3), 138-147 (1993)
  6. Marsh D., Concepts of fracture union, delayed union and nonunion, Clin Orthop., 35(5), 22-30 (1998)
  7. McKibbin B., The biology of fracture healing in long bones, J Bone Joint Surg Am.,60B,150-162 (1978)
  8. Leung K.S., Fung K.P., Sher A.H.L., Plasma bone specific alkaline phosphatase as an indicator of osteoblastic activity, J Bone Joint Surg Am., 75B, 288-292 (1993)
  9. Emami A., Larsson A. and Petren Mallmin M., Serum bone markers after intramedullary fixed tibial fractures, Clin Orthop,368, 220-229 (1999)
  10. Nyman M.T., Pavolainen P. and Forsius S., Clinical evaluation of fracture healing by serum osteocalcin and alkaline phosphatase, Ann Chir Gynaecol., 80, 289-293 (1991)
  11. Komnenou A., Karayannopoulou M., Polizopoulou Z.S., Constantinidis T.C. and Dessiris A., Correlation of serum alkaline phosphatase activity with healing process of long bone fractures in dogs, Vet Clin Patho;34(1), 35-38 (2005)
  12. Hosking D.J., Changes in serum alkaline phosphatase after femoral fractures, J. Bone Joint Surg Am; 60B, 61-65 (1978)
  13. Whelan D.B., Bhandari M., Stephen D., Kreder H., Mc Kee M.D., Zdero R. and Schemitsch E.H., Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after the medullary fixation, J Trauma,68(3), 629-632 (2010)
  14. Volpin G., Rees J.A. and Ali S.Y., Distribution of alkaline phosphatase activity in experimentally produced callus in rats, J Bone Joint Surg Am.,68B, 629-634 (1998)
  15. Seropoulos N.K. and Anagnostopoulos D., Ectopic bone formation in a child with a head injury: complete regression after immobilization, Int Orthop, 21, 412-414 (1997)
  16. Hooper G.J., Keddell R.G. and Penny I.D., Conservative management or closed nailing for tibial shaft fractures, A randomised prospective trial, J Bone Joint Surg, 73B, 83-85 (1991)
  17. Taylor J.C., Delayed union and non-union of fractures, In: Crenshaw AH, ed. Campbell's operative orthopaedics, 8th ed, 2., St. Louis: CV Mosby, 1287 (1992)
  18. Noordeen MH, Lavy CB, Shergill NS, et al. Cyclical micromovement and fracture healing. J Bone Joint Surg Br 77:645-648 (1995)
  19. Stannard J.P., Wilson T.C., Volgas D.A. and Alonso J.E., Fracture stabilization of proximal tibial fractures with the proximal tibial LISS, Injury, 34(1), 36-42 (2003)
  20. Nilsson B.E., Westlin N.E., The plasma concentration of alkaline phosphatase, phosphorus and calcium following femoral neck fracture, Acta Orthop Scand; 43, 504-510 (1972)