# ALP: An enzyme from your liver and your bones

> ALP comes from your liver and your bones. Check your result for your age and sex, see how to tell which is the source, and what to do if it’s high.

- Also called Alkaline phosphatase and Alk phos
- Often on a standard checkup
- Fast for 12 hours
- Web page: https://picardo.health/guides/biomarkers/alp

## The short answer

ALP is an enzyme made mostly by your liver and your bones. Labcorp’s adult range runs from about 40 to 135 IU/L, depending on your age and sex. A high result is a clue to a bile duct or bone problem, and a GGT test usually shows which.[1][8]

- **A good result:** 47 to 123 IU/L for men. For women, 41 to 116 up to age 50, and 49 to 135 after that.[8]
- **If yours is high:** Check GGT. If it’s raised too, the liver or bile ducts are the likely source. If not, it’s likely bone, for example from low vitamin D or a healing fracture.[1][2]
- **Should you test?** It comes with most checkup blood tests. If yours was high, retest it with GGT.[1]

## What is a normal ALP level?

Labcorp’s range depends on your age and sex. ALP runs higher in teenagers, because their bones are growing, and in women after 50, partly from bone turnover:[1][8]

Which fits you?

### Man

| Result (IU/L) | What it means |
| --- | --- |
| Under 47 | Below the lab range |
| 47 to 123 | In the normal range |
| 124 to 246 | Above the range: liver or bone? |
| 247 or more | High: see a clinician soon |

### Woman, 50 or younger

| Result (IU/L) | What it means |
| --- | --- |
| Under 41 | Below the lab range |
| 41 to 116 | In the normal range |
| 117 to 232 | Above the range: liver or bone? |
| 233 or more | High: see a clinician soon |

### Woman, 51 or older

| Result (IU/L) | What it means |
| --- | --- |
| Under 49 | Below the lab range |
| 49 to 135 | In the normal range |
| 136 to 270 | Above the range: liver or bone? |
| 271 or more | High: see a clinician soon |

### Below the lab range

**Range:** Under 47 IU/L for men; under 41 for women 50 or younger; under 49 for women 51 or older.

A single low ALP rarely means much. Common reasons include bone drugs such as bisphosphonates, low zinc or magnesium, an underactive thyroid, celiac disease, a recent serious illness or how the blood sample was handled.[7] If it stays low with no clear reason, it can point to hypophosphatasia, a rare inherited bone condition.[7]

**How worried to be:** Not a worry on its own.

**What to do next:**

1. If it’s low on more than one test, ask a clinician to look for a cause.[7]
2. Hypophosphatasia is diagnosed from an ALP that stays low with no other cause, plus at least two main signs, such as a gene test showing the variant, a raised vitamin B6 level or unusual thigh or repeated foot fractures. One main sign can count with two lesser ones, such as slow-healing fractures or early tooth loss.[7]
3. If your ALP stays low and you’re offered a bisphosphonate for your bones, mention it first. In hypophosphatasia these drugs can make things worse.[7]

[Test magnesium and TSH, $8.25](https://app.picardo.health/labs/order?tests=001537,004259&ref=guide-alp)

### In the normal range

**Range:** 47 to 123 IU/L for men; 41 to 116 for women 50 or younger; 49 to 135 for women 51 or older.

Your ALP is within Labcorp’s range for your age and sex.[8]

**How worried to be:** Nothing to worry about.

**What to do next:**

1. No follow-up needed for ALP itself.

### Above the range: liver or bone?

**Range:** 124 to 246 IU/L for men; 117 to 232 for women 50 or younger; 136 to 270 for women 51 or older.

ALP comes mostly from the liver and bone, so the first step is to find out which.[1] A GGT test does that. If GGT is raised too, the source is likely the liver; if it’s normal, bone is more likely.[1][2] When ALP is the only raised test, the most common causes are probably low vitamin D and, in teenagers, growing bones.[2]

**How worried to be:** Not urgent. Worth sorting out over the next few weeks.

**What to do next:**

1. Test GGT. If it’s raised, the usual next step is an ultrasound of the liver and bile ducts.[1]
2. If GGT is normal, check your vitamin D. Your calcium is on the same report.[2]
3. If you’re pregnant, a rise in the third trimester is normal. It comes from the placenta.[1]

[Test GGT and vitamin D, $14.25](https://app.picardo.health/labs/order?tests=001958,081950&ref=guide-alp)

### High: see a clinician soon

**Range:** 247 IU/L or more for men; 233 or more for women 50 or younger; 271 or more for women 51 or older.

That’s more than twice the upper limit. If the first tests don’t find a cause, guidelines suggest watching a smaller rise, but looking further at this level.[1] Causes include a blocked bile duct, autoimmune bile duct diseases such as PBC and PSC, medicines, Paget disease of bone and cancer that has spread to bone or liver.[1][2]

**How worried to be:** See a clinician in the next week or two. Get care today if your skin or the whites of your eyes turn yellow.[2]

**What to do next:**

1. Test GGT, and ask about an ultrasound of the liver and bile ducts.[1]
2. If GGT is raised, ask about the antibody test for PBC, called AMA.[1]

[Test GGT and the PBC antibody (AMA), $13.25](https://app.picardo.health/labs/order?tests=001958,006650&ref=guide-alp)

## What is ALP?

> ALP has two main homes, your liver and your bones, so one number can’t tell you which is behind a rise. GGT, which isn’t found in bone, is the tiebreaker.

ALP, short for alkaline phosphatase, is an enzyme found mostly in the liver, where it sits along the tiny channels that carry bile, and in bone. Smaller amounts come from the intestines and kidneys and, in pregnancy, the placenta.[1][2]

## Is high ALP from your liver or your bones?

A GGT test, taken at the same time, usually answers it:[1][2]

| ALP | GGT | Likely source |
| --- | --- | --- |
| High | High | Liver or bile ducts |
| High | Normal | Bone, pregnancy or another source outside the liver |

GGT is in the liver but not in bone.[1][2]

If the source is still unclear, a lab can split ALP into its liver and bone forms.[2]

## What raises ALP?

From the liver and bile ducts:[1][2]

- A blocked bile duct, from gallstones or, less often, a tumor
- Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), which damage the bile ducts
- Some medicines

From bone:[1][2]

- Low vitamin D
- Growing bones in children and teens, and healing fractures
- Paget disease of bone, and cancer that has spread to bone

Other causes:[1]

- Pregnancy, in the third trimester
- A fatty meal, in some people with blood type O or B
- An overactive thyroid or parathyroid gland, and kidney failure

## How to lower ALP

- **Treating low vitamin D:** Probably the most common reason for a raised ALP when the other liver tests are normal.[2] How much it helps: some. How sure we are: fairly sure.
- **Stopping a medicine that’s behind it:** Some medicines slow the flow of bile and raise ALP. Ask before stopping a prescribed medicine.[1] How much it helps: a lot. How sure we are: fairly sure.
- **Treating PBC:** Ursodeoxycholic acid (UDCA) comes first. If it isn’t enough, or you can’t take it, newer drugs called PPAR agonists can help. The aim is an ALP under about 1.5 times the upper limit after a year, and ideally a normal one.[3] How much it helps: a lot. How sure we are: fairly sure.
- **Treating Paget disease of bone:** Guidelines treat bone pain rather than aiming to bring ALP back to normal.[6] How much it helps: some. How sure we are: fairly sure.

Treatment for PBC is changing fast. In 2024 the FDA approved two newer drugs for people whose PBC isn’t controlled by UDCA or who can’t take it: elafibranor in June and seladelpar in August. Both approvals are accelerated, and the trials checking whether they improve longer-term outcomes are due in 2030.[4] An older option, obeticholic acid (Ocaliva), was withdrawn from the US market in November 2025.[5] In March 2026 the FDA approved linerixibat (Lynavoy) for the itching PBC can cause.[9] A new US guideline from the American Gastroenterological Association and the American Association for the Study of Liver Diseases, published in October 2026, firmly recommends UDCA first. Its advice on the newer drugs, when UDCA isn’t enough or can’t be tolerated, and on linerixibat for moderate to severe itching, is weaker, because the evidence is less certain.[3]

## Who should get an ALP test?

ALP comes on the comprehensive metabolic panel, so most people get it with routine blood work. It’s worth a closer look if:

- Your ALP was high before. Retest it with GGT to find the source.[1]
- You have other raised liver tests.[1]
- You have bone pain or a bone deformity that could be Paget disease of bone. ALP, with your other liver tests, is the first blood test for it.[6]

## How to get an ALP test, and what it costs

It comes from the comprehensive metabolic panel, which costs $4.00 through Picardo.

- [Comprehensive metabolic panel, $4.00](https://app.picardo.health/labs/order?tests=322000&ref=guide-alp). The test this number comes from. Labcorp 322000, fast for 12 hours.

Every order comes with:

- Results in 2 to 3 days, in the app
- Physician follow-up if you want one
- Free Labcorp draw, or $75 at home
- No other fees. HSA and FSA eligible.

It’s also part of the [Base Core Annual – Men](https://picardo.health/labs/panels/base-core-men), [Base Core Annual – Women](https://picardo.health/labs/panels/base-core-women), [Heart Health](https://picardo.health/labs/panels/heart-health), [Brain Health Screening](https://picardo.health/labs/panels/brain-health), [Pregnancy](https://picardo.health/labs/panels/pregnancy), [Postpartum](https://picardo.health/labs/panels/postpartum), [Fertility](https://picardo.health/labs/panels/fertility), [Thyroid & Autoimmunity](https://picardo.health/labs/panels/thyroid-autoimmunity) and [Celiac / GI](https://picardo.health/labs/panels/celiac-gi) panels, if you’d rather test more at once.

Already have a result? [Ask Picardo about it](https://app.picardo.health/auth).

## Questions people ask

### Is ALP high in pregnancy?

Often, in the third trimester. The placenta makes its own ALP, so a rise then is normal.[1]

### Can eating raise ALP?

In some people, yes. In people with blood type O or B, a fatty meal can push ALP up a little, from the intestines.[1]

### Why is ALP higher in teenagers?

Because their bones are growing. Labcorp’s range for a 13-year-old boy runs up to 435 IU/L, against 123 for adult men.[8] Growth is a common reason for a raised ALP in children.[2]

### What is PBC?

Primary biliary cholangitis is a long-term autoimmune disease that slowly damages the small bile ducts in the liver. It’s more common in women than in men.[1] It raises ALP, and more than 95% of people with it have an antibody called AMA, which a blood test can find.[1]

## Often checked alongside

- [GGT](https://picardo.health/guides/biomarkers/ggt.md): A liver enzyme that rises with alcohol
- [ALT](https://picardo.health/guides/biomarkers/alt.md): The enzyme most specific to liver damage
- [Bilirubin](https://picardo.health/guides/biomarkers/bilirubin.md): Waste pigment used to assess liver function and bile flow
- [Vitamin D](https://picardo.health/guides/biomarkers/vitamin-d.md): How much vitamin D you have stored

## Test details

- **Labcorp test:** Metabolic Panel (14), Comprehensive, 322000
- **LOINC:** 6768-6
- **Sample:** Blood
- **Fasting:** The metabolic panel asks for 12 hours, for its glucose result. A fatty meal can nudge ALP up in some people.[1]
- **Typical lab range:** 47 to 123 IU/L (men); 41 to 116 IU/L (women 21 to 50); 49 to 135 IU/L (women 51 to 80); 48 to 129 IU/L (over 80)[8]
- **Units:** IU/L, the same as U/L

## Sources

1. Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017;112(1):18–35. https://doi.org/10.1038/ajg.2016.517
2. Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests. Gut. 2018;67(1):6–19. https://doi.org/10.1136/gutjnl-2017-314924
3. Levy C, Mayo MJ, Carey EJ, et al. AGA/AASLD clinical practice guideline on management of primary biliary cholangitis. Gastroenterology. 2026;171(5):817–839. https://doi.org/10.1053/j.gastro.2026.08.025
4. US Food and Drug Administration. Ongoing: non-malignant hematological, neurological, and other disorder indications accelerated approvals. Updated August 25, 2026. https://www.fda.gov/drugs/accelerated-approval-program/ongoing-non-malignant-hematological-neurological-and-other-disorder-indications-accelerated
5. US Food and Drug Administration. Withdrawn: non-malignant hematological, neurological, and other disorder indications accelerated approvals. Updated February 25, 2026. https://www.fda.gov/drugs/accelerated-approval-program/withdrawn-non-malignant-hematological-neurological-and-other-disorder-indications-accelerated
6. Ralston SH, Corral-Gudino L, Cooper C, et al. Diagnosis and management of Paget’s disease of bone in adults: a clinical guideline. J Bone Miner Res. 2019;34(4):579–604. https://doi.org/10.1002/jbmr.3657
7. Khan AA, Brandi ML, Rush ET, et al. Hypophosphatasia diagnosis: current state of the art and proposed diagnostic criteria for children and adults. Osteoporos Int. 2024;35(3):431–438. https://doi.org/10.1007/s00198-023-06844-1
8. Labcorp. Alkaline phosphatase, test 001107. Labcorp test menu. Accessed October 28, 2026. https://www.labcorp.com/tests/001107/alkaline-phosphatase
9. US Food and Drug Administration. Novel drug approvals for 2026. Updated October 20, 2026. https://www.fda.gov/drugs/novel-drug-approvals-fda/novel-drug-approvals-2026

Updated 2026-10-28. This is general health information, not medical advice: talk to your clinician about your results and before changing any treatment.