Clinical Investigation of C-Terminal Cross-Linking Telopeptide Test in Prevention and Management of Bisphosphonate-Associated Osteonecrosis of the Jaws

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dc.contributor.authorKunchur, R.
dc.contributor.authorNeed, A.
dc.contributor.authorHughes, T.
dc.contributor.authorGoss, A.
dc.date.issued2009
dc.descriptionCrown copyright © 2009 Published by Elsevier Inc.
dc.description.abstract<h4>Purpose</h4>The aim of this study was to determine, in a clinical setting, the effectiveness of the C-terminal cross-linking telopeptide test (CTX) test in the prevention and management of osteonecrosis of the jaws (ONJ) in patients taking bisphosphonates.<h4>Patients and methods</h4>A total of 348 patients underwent a fasted morning CTX test. Of these, 222 were patients at risk of ONJ who had been referred for extractions, 15 had ONJ, and 113 were controls.<h4>Results</h4>The 215 patients taking long-term oral bisphosphonates were older (71 +/- 11.6 years), were predominantly women with osteoporosis, and were medically compromised. The average CTX value was 238 +/- 144 pg/mL, with 98 having a value less than 200 pg/mL. One patient with a CTX value of 126 pg/mL developed ONJ after an extraction. Seven intravenous bisphosphonate patients underwent extractions with no cases of ONJ developing. The CTX value was 329 +/- 354, with 4 less than 200 pg/mL. Fifteen patients developed ONJ, 12 after extractions and 3 spontaneously. Of these, 7, who were still taking a bisphosphonate at presentation, had a CTX value of 116 pg/mL. A CTX value of less than 150 pg/mL did not correlate with the clinical risk factors of age, gender, comorbidities, bone disease, or bisphosphonate duration. A statistically significant difference in the CTX value was found for those taking alendronate compared with those taking risedronate (P < .0001). If the bisphosphonate was ceased, the CTX value increased at approximately 25 pg/mL per month.<h4>Conclusions</h4>The CTX test is not predictive of the development of ONJ for an individual patient but does identify those in the "risk zone," which is a value of less than 150 pg/mL to 200 pg/mL. If medically appropriate, the bisphosphonate can be ceased so that the CTX value increases to bring the patient out of the "risk zone."
dc.description.statementofresponsibilityRanjit Kunchur, Allan Need, Toby Hughes and Alastair Goss
dc.description.urihttp://www.elsevier.com/wps/find/journaldescription.cws_home/623146/description#description
dc.identifier.citationJournal of Oral and Maxillofacial Surgery, 2009; 67(6):1167-1173
dc.identifier.doi10.1016/j.joms.2009.02.004
dc.identifier.issn0278-2391
dc.identifier.issn1531-5053
dc.identifier.orcidHughes, T. [0000-0001-8668-7744]
dc.identifier.orcidGoss, A. [0000-0002-2658-3836]
dc.identifier.urihttp://hdl.handle.net/2440/50647
dc.language.isoen
dc.publisherW B Saunders Co
dc.source.urihttps://doi.org/10.1016/j.joms.2009.02.004
dc.subjectHumans
dc.subjectOsteoporosis
dc.subjectOsteonecrosis
dc.subjectJaw Diseases
dc.subjectChronic Disease
dc.subjectDiphosphonates
dc.subjectAlendronate
dc.subjectEtidronic Acid
dc.subjectCollagen Type I
dc.subjectPeptides
dc.subjectTooth Extraction
dc.subjectAdministration, Oral
dc.subjectInjections, Intravenous
dc.subjectRisk Factors
dc.subjectPredictive Value of Tests
dc.subjectAge Factors
dc.subjectSex Factors
dc.subjectImmunocompromised Host
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.subjectBone Density Conservation Agents
dc.subjectBiomarkers
dc.subjectRisedronic Acid
dc.titleClinical Investigation of C-Terminal Cross-Linking Telopeptide Test in Prevention and Management of Bisphosphonate-Associated Osteonecrosis of the Jaws
dc.typeJournal article
pubs.publication-statusPublished

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