A 75-Year-Old Man Comes to the Office for a Routine

A 75-year-old man comes to the office for a routine preventive examination.  He has no ongoing symptoms.  The patient's medical history is significant for osteoarthritis, hypertension, and hyperlipidemia.  Current medications include hydrochlorothiazide and atorvastatin.  He does not smoke and consumes 1 or 2 beers on weekends.  The patient walks 2 miles every morning and eats a balanced diet.  Vital signs are within normal limits.  His cardiopulmonary examination is normal, and his abdomen is soft and nontender.  Rectal examination shows a diffusely enlarged prostate without nodules.  The distal interphalangeal joints are enlarged, and his gait is normal.  Laboratory results are as follows: Which of the following is the most likely cause of the elevated alkaline phosphatase in this patient?

A) Adverse effect of medication
B) Alcohol use
C) Metastatic bone disease
D) Paget disease of bone
E) Plasma cell neoplasia

Correct Answer:

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