Irish Journal of Medical Science

, Volume 181, Issue 2, pp 237–242

A role for C-terminal cross-linking telopeptide (CTX) level to predict the development of bisphosphonate-related osteonecrosis of the jaws (BRONJ) following oral surgery?

Original Article

DOI: 10.1007/s11845-011-0790-5

Cite this article as:
O’Connell, J.E., Ikeagwani, O. & Kearns, G.J. Ir J Med Sci (2012) 181: 237. doi:10.1007/s11845-011-0790-5



Bisphosphonates are a class of chemical compounds used in the treatment of a variety of bone-related conditions. Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a well-recognised complication. C-terminal cross-linking telopeptide (CTX) estimation has been suggested as an indicator for the risk of BRONJ. It was reported that values <100 pg/ml represent a high risk of developing BRONJ following surgery and those between 100 and 150 pg/ml, a moderate risk. The aim of this study was to determine the effectiveness of the CTX test in predicting the development of BRONJ.


This is an 18-month-prospective study of patients taking bisphosphonates, referred to a regional Maxillofacial Surgery Unit for dento-alveolar surgery. The following variables were recorded: age, gender, reason for referral, bisphosphonate type, indication for and duration of bisphosphonate treatment, medical co-morbidities, CTX value, development of BRONJ, and follow-up period.


23 patients underwent a fasting CTX test. The mean age was 59 years (range, 44–78 years). Nineteen were taking alendronic acid, two risedronate sodium and two zoledronic acid. The mean duration of bisphosphonate treatment was 30 months (range, 8–72 months). The mean CTX value was 180 pg/ml (range, 50–370 pg/ml), with 11 patients having a value at or less than 150 pg/ml. The mean follow-up period was 5 months (range, 3–11 months). None of the patients, who underwent removal of one or more teeth, subsequently developed BRONJ.


The CTX test was not predictive for the development of BRONJ following oral surgery.


CTX BRONJ Bisphosphonates Osteonecrosis Jaws 

Copyright information

© Royal Academy of Medicine in Ireland 2012

Authors and Affiliations

  • J. E. O’Connell
    • 2
  • O. Ikeagwani
    • 1
  • G. J. Kearns
    • 2
  1. 1.Oral SurgeonCahercallaEnnisIreland
  2. 2.Department of Oral and Maxillofacial SurgerySt James’s HospitalDublin 8Ireland

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