Serum Alkaline Phosphatase as a Biomarker for Skeletal Maturity Assessment and Growth Prediction in Individuals Aged 7 to 17 Years
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This study explored the association between serum alkaline phosphatase (ALP) levels and skeletal maturity and assess its potential as a hypothesis-generating adjunctive biomarker. One-hundred fifty-one subjects aged 7 ‒ 17 years who underwent handwrist radiography and serum ALP blood tests on the same day were enrolled retrospectively. Skeletal maturity was assessed using a Skeletal Maturity Indicator system, and serum alkaline phosphatase levels were measured using enzymatic colorimetry. Kruskal-Wallis tests, Spearman’s correlation, and multinomial logistic regression examined the relationship between ALP, chronological age, and skeletal maturity classification. Serum ALP levels showed significant differences across skeletal maturity stages (p < 0.0001), with the highest levels observed at SMI stages 6 ‒ 8. No significant sex-based differences were found (p = 0.226), and serum ALP levels were not linearly correlated with chronological age (ρ = 0.018, p = 0.824). A multinomial logistic regression model combining age and ALP level yielded improved classification accuracy for skeletal maturity (McFadden R² = 0.601, accuracy = 82.1%) compared to age alone. These findings suggested that serum ALP may partially reflect physiological bone maturation, and could be considered as a supplementary reference for skeletal maturity assessment if interpreted alongside chronological age.
Abstract
This study explored the association between serum alkaline phosphatase (ALP) levels and skeletal maturity and assess its potential as a hypothesis-generating adjunctive biomarker. One-hundred fifty-one subjects aged 7 ‒ 17 years who underwent handwrist radiography and serum ALP blood tests on the same day were enrolled retrospectively. Skeletal maturity was assessed using a Skeletal Maturity Indicator system, and serum alkaline phosphatase levels were measured using enzymatic colorimetry. Kruskal-Wallis tests, Spearman’s correlation, and multinomial logistic regression examined the relationship between ALP, chronological age, and skeletal maturity classification. Serum ALP levels showed significant differences across skeletal maturity stages (p < 0.0001), with the highest levels observed at SMI stages 6 ‒ 8. No significant sex-based differences were found (p = 0.226), and serum ALP levels were not linearly correlated with chronological age (ρ = 0.018, p = 0.824). A multinomial logistic regression model combining age and ALP level yielded improved classification accuracy for skeletal maturity (McFadden R² = 0.601, accuracy = 82.1%) compared to age alone. These findings suggested that serum ALP may partially reflect physiological bone maturation, and could be considered as a supplementary reference for skeletal maturity assessment if interpreted alongside chronological age.