CTX Biochemical Marker of Bone Metabolism. Is it a Reliable Predictor of Bisphosphonate-Associated Osteonecrosis of the Jaws After Surgery? Part I: Biological Concepts With a Review of the Literature

Abstract

Biochemical markers of bone metabolism have been used in medicine to evaluate and provide treatment to patients with metabolic bone diseases, such as osteoporosis. Serum cross-linked C-telopeptide of type I collagen is a marker of osteoclast activity and is used to assess the level of bone resorption. Recently, in oral and maxillofacial surgery, it was proposed that the levels of serum cross-linked C-telopeptide of type I collagen may predict the subsequent risk of developing osteonecrosis of the jaws after oral surgery procedures for patients taking oral bisphosphonates. The astute clinician must critically review the scientific literature and must decide if biochemical markers of bone resorption are of benefit in managing the oral surgery patient on bisphosphonates.

Adseverin plays a role in osteoclast differentiation and periodontal disease‐mediated bone loss

“…The Ads‐null mice displayed a normal bone phenotype. Although this in vivo observation needs to be further investigated by the evaluation of serum cross‐linked C‐ and N‐terminal telopeptides of collagen type I, which are released to the bloodstream during bone desorption and are thought as sensitive surrogate markers of osteoclast activity (28, 29). Interestingly, Ads‐null mice are protected from osteoclast‐mediated bone loss in a periodontitis model.…”

Identification and Treatment of Bisphosphonate-Associated Actinomycotic Osteonecrosis of the Jaws

“…38 However, as bisphosphonates have a long half life, we do not have a set duration for a "drug holiday." 39 This is despite the fact that the American Association of Oral and Maxillofacial Surgeons position paper recommends a 3-month drug holiday before treatment for patients taking the oral formulation of bisphosphonates for more than 3 years.…”

Important aspects concerning alendronate‐related osteonecrosis of the jaws: a literature review

“…Some authors agree and others disagree with these concepts of drug holiday and CTX defended by Marx et al . According to Baim and Miller, serum CTX as a predictor of BRONJ has yet to receive rigorous evidence‐based validation, and there are currently insufficient data to support using CTX levels to guide the modification of bisphosphonate therapy in such a way as to minimise the risk of developing BRONJ.…”