In Paget's disease, which enzyme marker is markedly elevated?

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Paget's disease causes accelerated bone remodeling with heightened osteoblast activity, so markers of bone formation rise. Among serum enzymes, alkaline phosphatase stands out as markedly elevated because it is produced by osteoblasts during new bone mineralization. Calcium and phosphate usually stay normal because the body maintains mineral balance despite the rapid turnover. ACP is not a typical marker for Paget's disease, and amylase is related to pancreatic or salivary disorders, not bone remodeling. Measuring alkaline phosphatase (ideally a bone-specific isoenzyme) provides a good sense of disease activity and helps follow response to therapy such as bisphosphonates.