Thank you for citing the article. I found it interesting. The elevation in my ALP was not unexpected and may be a good sign since I am supposedly growing new bone with treatment. If you are not growing new bone, it is likely a sign of bone breakdown. At age 73, I would not be growing appreciable new bone without medication. My ALT was not elevated, but my AST was and my doctor does not see a reason to think it is related to the medication I am taking. However, it has increased at the same time and at a similar rate since I started Tymlos after having been stable for 25 years.