What further endocrine work up do you recommend for chronically elevated bone specific alkaline phosphatase levels in young asymptomatic patients with normal nuclear bone scan results and no evidence of osteomalacia?

I am sure that you are aware that the differential diagnosis for an elevated alkaline phosphatase includes Paget's disease, vitamin D deficiency, hyperparathyroidism, hyperthyroidism, occult malignancy, bone metastases, and primary bone tumors. A normal bone scan helps to eliminate many of these. Bu...