<prompt> Serum alkaline phosphate is normal in: September 2009OsteosarcomaOsteomalaciaMultiple myelomaMalnutrition  <response>: Ans. C: Multiple Myeloma I. Increased alkaline phosphatase levels: Increased calcium deposition in bone Hyperparathryroidism Pagets disease Osteomalacia rickets: in both cases there is failure of mineralization; Caffeys syndrome infantile coical hyperostosis Osteoblastic bone tumors metastatic or osteogenic sarcoma alkaline phosphatase level is high in about 12 of patients with osteosarcoma in smaller fraction of those with another type of primary malignant bone tumor; Pregnancy Childhood Liver disease such as biliary obstruction Total Parenteral Nutrition TPN II. Decreased alkaline phosphatase levels: Malnutrition Excess Vit D ingestion; Hypophosphatasia 