Serologic bone markers for predicting development of osteonecrosis of the jaw in patients receiving bisphosphonates.
OBJECTIVE
Osteonecrosis of the jaw is a well-documented side effect of bisphosphonate (BP) use. Attempts have recently been made to predict the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). We prospectively investigated the predictive value of serum levels of C-terminal telopeptide of collagen I (CTX), bone-specific alkaline phosphatase, and parathyroid hormone for the development of BRONJ.


METHODS
Data on the demographics, comorbidities, and BP treatment were collected from 78 patients scheduled for dentoalveolar surgery. Of the 78 patients, 51 had been treated with oral BPs and 27 had been treated with frequent intravenous infusions of BPs. Blood samples for CTX, bone-specific alkaline phosphatase, and parathyroid hormone measurements were taken preoperatively. Surgery was performed conservatively, and antibiotic medications were prescribed for 7 days.


RESULTS
Of the 78 patients, 4 patients taking oral BPs (7.8%) and 14 receiving intravenous BPs (51.8%) developed BRONJ. A CTX level less than 150 pg/mL was significantly associated with BRONJ development, with an increased odds ratio of 5.268 (P = .004). The bone-specific alkaline phosphatase levels were significantly lower in patients taking oral BPs who developed BRONJ. The parathyroid hormone levels were similar in patients who did and did not develop BRONJ.


CONCLUSIONS
The incidence of BRONJ after oral surgery involving bone is greater among patients receiving frequent, intravenous infusions of BPs than among patients taking oral BPs. Although the measurement of serum levels of CTX is not a definitive predictor of the development of BRONJ, it might have an important role in the risk assessment before oral surgery.
Lazarovici
Towy Sorel
TS
Resident, Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Israel.
Mesilaty-Gross
Shlomit
S
Vered
Iris
I
Pariente
Clara
C
Kanety
Hannah
H
Givol
Navot
N
Yahalom
Ran
R
Taicher
Shlomo
S
Yarom
Noam
N
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016009:Chi-Square Distribution; D024042:Collagen Type I / Q000097:blood*; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007571:Jaw Diseases / Q000097:blood* / Q000139:chemically induced; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019647:Oral Surgical Procedures / Q000009:adverse effects; D010020:Osteonecrosis / Q000097:blood* / Q000139:chemically induced; D010281:Parathyroid Hormone / Q000097:blood; D010455:Peptides / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D055815:Young Adult
D015415:Biomarkers; D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D004164:Diphosphonates; D010281:Parathyroid Hormone; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; C548267:ALPL protein, human; D000469:Alkaline Phosphatase