J Korean Assoc Oral Maxillofac Surg.  2011 Feb;37(1):1-8. 10.5125/jkaoms.2011.37.1.1.

Clinical study of correlation between C-terminal cross-linking telopeptide of type I collagen and risk assessment, severity of disease, healing after early surgical intervention in patients with bisphophonate-related osteonecrosis of the jaws

• Song JW
• Kim KH
• Song JM
• Chun BD
• Kim YD
• Kim UK
• Shin SH

• KMID: 2189799
• DOI: http://doi.org/10.5125/jkaoms.2011.37.1.1

Abstract

INTRODUCTION
The utility of the C-terminal cross-linking telopeptide test (CTX) as a method for staging Bisphosphonate-related osteonecrosis of the jaws (BRONJ) and its healing process was examined.
MATERIALS AND METHODS
A total 19 patients who were diagnosed with BRONJ underwent a fasted morning CTX test, were enrolled in this study. The serum CTX values ranged from 50 to 630 pg/mL (mean 60). The risk assessment was rated according to the CTX values of the individual patient (minimal risk, > or =150 pg/mL, moderate, 100 to 150 pg/mL, high, < or =100 pg/mL). The BRONJ scores were then calculated according to the number of BRONJ lesions and their stage. The operation was done as soon as possible, regardless of BORNJ stage.
RESULTS
The mean duration of bisphosphonate therapy was 4.1 years. Of the 19 patients, 15, 2 ans 2 received alendronate, risedronate and zoledronate, respecively. Of the 19 patients who underwent a sequestrectomy, saucerization and smoothing, 15 healed after the initial surgery, 1 patient healed after one more surgical procedure, 3 patients did not heal completely but showed improvement in symptoms. Therefore, 17 out of the 19 patients healed completely with complete mucosal coverage and the elimination of pain. The risk assessment using the CTX value and disease severity were not correlated (r=-0.264, P=0.275). In addition, the risk assessment using CTX value and healing after surgery were not correlated (r=-0.147, P=0.547).
CONCLUSION
The serum CTX should be considered carefully by clinicians as part of overall management. Early surgical intervention is of benefit in the treatment of stage II BRONJ.

Keyword

Bisphosphonates; Osteonecrosis; Bisphosphonate-related osteonecrosis of the jaws (BRONJ); Jaw diseases; Collagen type I trimeric cross-linked peptide

MeSH Terms

Alendronate
Bisphosphonate-Associated Osteonecrosis of the Jaw
Collagen Type I
Diphosphonates
Etidronic Acid
Humans
Imidazoles
Jaw
Jaw Diseases
Osteonecrosis
Peptides
Risk Assessment
Risedronate Sodium
Alendronate
Collagen Type I
Diphosphonates
Etidronic Acid
Imidazoles
Peptides

Figure

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  Fig. 1. Structures of bisphosphonate and pyrophosphonate.

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  Fig. 2. The lamina dura remains after extraction.

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  Fig. 3. Bone sequestration on mandible after extraction.

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  Fig. 4. Bone sequestration on left maxilla with purulent sinusitis.

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  Fig. 5. Scatter graph of preoperative BRONJ score and CTX values.(pg/mL) (BRONJ: bisphosphonate-related osteonecrosis of the jaw, CTX: C-terminal cross-linking telopeptide test)

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  Fig. 6. Scatter graph of BRONJ score change after operation and CTX values.(pg/mL) (BRONJ: bisphosphonate-related osteonecrosis of the jaw, CTX: C-terminal cross-linking telopeptide test)

Reference

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