title: Salivary Biomarkers Associated With Bone Deterioration in Patients With Medication-Related Osteonecrosis of the Jaws.
abstract: OBJECTIVE
  The purpose of this study was to investigate the use of saliva as a medium for the identification of biomarkers associated with bone resorption and formation. The authors hypothesized that biomarkers, such as N-telopeptide of type I collagen (NTX) and bone-specific alkaline phosphatase (B-AP), could be identified in saliva. They further hypothesized that there would be a difference between these biomarkers in the saliva of patients with medication-relation osteonecrosis of the jaws (MRONJ) and those who have no risk factors for the development of MRONJ.
  
  
  METHODS
  This case-and-control study compared 2 salivary biomarkers, NTX and B-AP, in a group of patients with MRONJ and a control group. The predictor variable was the presence or absence of the disease (MRONJ or control group); the outcome variables were the levels of the 2 salivary biomarkers, NTX and B-AP. Saliva samples from 20 patients with a diagnosis of MRONJ and 14 control participants who were comparable to the study group with no history of antiresorptive medication use were collected. The saliva samples were analyzed using 2 commercially available assays for NTX and B-AP to evaluate for levels of each marker. A 2-tailed t test for 2 groups of unequal distribution was used for statistical analysis, with P values less than .05 considered statistically.
  
  
  RESULTS
  The 2 biomarkers, NTX and B-AP, were detected in saliva samples from the MRONJ and control groups. A statistically significant difference was found in the levels of NTX in saliva of patients with MRONJ compared with the control participants (P = .0067).
  
  
  CONCLUSIONS
  In this exploratory study, the 2 bone deterioration biomarkers (NTX and B-AP) were detected in saliva. There was a statistical difference in the levels of salivary NTX between patients with MRONJ and controls. Saliva evaluation could provide a novel method to detect, diagnose, stage, and potentially guide treatment decisions and monitor outcomes for patients with MRONJ in the future.
authors.affiliation: Associate Professor, Program Director, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, College of Dentistry and the University of Illinois Hospitals and Health Science Center, Chicago, IL. Electronic address: akolokythas@yahoo.com.
authors.forename: Antonia
authors.initials: A
authors.lastname: Kolokythas
authors.affiliation: Dental Student, University of Illinois at Chicago, College of Dentistry and the University of Illinois Hospitals and Health Science Center, Chicago, IL.
authors.forename: Maria
authors.initials: M
authors.lastname: Karras
authors.affiliation: Former Chief Resident, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, College of Dentistry and the University of Illinois Hospitals and Health Science Center, Chicago, IL.
authors.forename: Edward
authors.initials: E
authors.lastname: Collins
authors.affiliation: Clinical Professor, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, College of Dentistry and the University of Illinois Hospitals and Health Science Center, Chicago, IL.
authors.forename: William
authors.initials: W
authors.lastname: Flick
authors.affiliation: Professor and Head, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, College of Dentistry and the University of Illinois Hospitals and Health Science Center, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Miloro
authors.affiliation: Associate Professor, Department of Oral Medicine and Diagnostic Sciences, University of Illinois at Chicago, College of Dentistry and the University of Illinois Hospitals and Health Science Center, Chicago, IL.
authors.forename: Guy
authors.initials: G
authors.lastname: Adami
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000378:metabolism / Q000473:pathology*; D016022:Case-Control Studies; D024042:Collagen Type I / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000378:metabolism*; D012463:Saliva / Q000201:enzymology / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D000469:Alkaline Phosphatase