Not a feature of multiple myeloma
High-Yield Explanation
Answwe is option 4, elevated alkaline phosphatase. Alkaline phosphatase only increase if there is a bone fracture along with multiple myeloma Bone-specific ALP may increase in Paget's disease, osteosarcoma, bone metastases of prostatic cancer (high/very high ALP values), other bone metastases, fractured bones, multiple myeloma (only when associated with fractures), osteomalacia, rickets, vitamin D deficiency (moderate rise), malignant tumors (ALP originating from tumors), renal disease (secondary hyperparathyroidism), and primary hypothyroidism