Serum N-Telopeptide and Bone-Specific Alkaline Phosphatase Levels in Patients With Osteonecrosis of the Jaw Receiving Bisphosphonates for Bone Metastases

• Published in: Journal of oral and maxillofacial surgery Vol. 70; no. 12; pp. 2768 - 2775
• Main Authors: Morris, Patrick G., MD, Fazio, Maurizio, Farooki, Azeez, MD, Estilo, Cherry, DMD, Mallam, Divya, Conlin, Alison, MD, Patil, Sujata, PhD, Fleisher, Martin, PhD, Cremers, Serge, PhD, Huryn, Joseph, DDS, Hudis, Clifford A., MD, Fornier, Monica N., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-12-2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Alkaline Phosphatase - analysis; Biological and medical sciences; Biomarkers - blood; Bisphosphonate-Associated Osteonecrosis of the Jaw - blood; Bisphosphonate-Associated Osteonecrosis of the Jaw - enzymology; Bone and Bones - enzymology; Bone Density Conservation Agents - administration & dosage; Bone Neoplasms - drug therapy; Bone Neoplasms - secondary; Bones, joints and connective tissue. Antiinflammatory agents; Breast Neoplasms - pathology; Collagen Type I - blood; Dentistry; Diphosphonates - administration & dosage; Diseases of the osteoarticular system; Female; Follow-Up Studies; Forecasting; Humans; Male; Medical sciences; Middle Aged; Otorhinolaryngology. Stomatology; Peptides - blood; Pharmacology. Drug treatments; Prostatic Neoplasms - pathology; Retrospective Studies; Surgery; Time Factors; Vascular bone diseases; Human; Alkaline phosphatase; Jaw; Antiosteoporotic; Enzyme; Stomatology; Diseases of the osteoarticular system; Phosphoric monoester hydrolases; Esterases; Osteonecrosis; Malignant tumor; Bisphosphonates; Bone metastasis; Treatment; Antiosteoclastic agent; Surgery; Hydrolases; Serum; Bone; Cancer
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1016/j.joms.2011.12.028

Purpose Oversuppression of bone turnover can be a critical factor in the pathogenesis of osteonecrosis of the jaw (ONJ). We investigated N-telopeptide of type I collagen (NTX) and bone-specific alkaline phosphatase (BAP) as potential predictors of ONJ onset. Patients and Methods Patients with ONJ and available stored serum were identified retrospectively from the institutional databases. Four approximate points were examined: point of ONJ diagnosis and 12, 6, and 1 month before the diagnosis. NTX and BAP were measured using enzyme-linked immunosorbent assays and examined as possible predictors of ONJ. Results From March 1998 to September 2009, we identified 122 patients with ONJ. Of these, 56 (46%) had one or more serum samples available. Overall, 55 patients (98%) received bisphosphonates. Using the exact dates, no obvious patterns in either NTX or BAP were noted. Similarly, using the ordinal points, no evidence of suppression of NTX or BAP over time was seen. The consecutive median values were as follows: The median NTX values were 8.0 nmol/L (range 3.8 to 32.9) at 12 months before ONJ; 9.5 nmol/L (range 4.7 to 42.7) at 6 months; 9.5 nmol/L (range 4.5 to 24.6) at 1 month, and 10.4 nmol/L (range 4.4 to 32.5) at the ONJ diagnosis. The median BAP values were BAP 18.0 U/L (range 7.0 to 74) at 12 months before ONJ; 18.0 U/L (range 4.0 to 134) at 6 months; 14.0 U/L (range 4.0 to 132) at 1 month, and 18.0 U/L (range 0.7 to 375) at the ONJ diagnosis. Only 2 patients (4%) had NTX and 17 (30%) had BAP below the normal range at the ONJ diagnosis. Conclusions In the present large retrospective study, no trends were seen in the NTX and BAP levels before the ONJ diagnosis.