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Table 1 Overview of different differential diagnoses for decreased ALP activity. Modified from (13)

From: Prevalence of low alkaline phosphatase activity in laboratory assessment: Is hypophosphatasia an underdiagnosed disease?

Causes of low ALP activity
Hypophosphatasia (HPP)
Osteogenesis imperfecta
Cleidocranial dysplasia
Mseleni joint disease
Vitamin D intoxication
Multiple myeloma
Wilson's disease
Vitamin C deficiency
hypothyroidism
Zn++ or Mg++ deficiency
Cushing's syndrome
Milk-alkali syndrome
Celiac disease
Starvation
Bisphosphonate therapy