Andriana Delaka1, Nikolaos Mourmouras2, Flora Zervou-Valvi3, Konstantinos Stravodimos4, Ioannis Anastasiou5, Dimitrios Delakas6. 1. Oral Surgeon. Medical School of Athens. Paleo Faliro. Athens. Greece. 2. Consultant Urologist. Asklepieion Hospital of Athens. Greece. 3. Director of Dental Department. Asklepieion Hospital of Athens. Greece. 4. Associate Professor of Urology. Laikon University Hospital of Athens. Greece. 5. Assistant Professor of Urology. Laikon University Hospital of Athens. Greece. 6. Director of Urology Department. Asklepieion Hospital of Athens. Voula. Athens. Greece.
Abstract
OBJECTIVE: To examine the predictive value of osteocalcin (OC) and C-terminal telopeptide (CTX) levels for jaw osteonecrosis in high-risk prostate cancer (PCa) patients taking bisphosphonates (BPs). METHODS: Twenty-four patients were prospectively recruited in this study and followed from 2011 to 2015. All patients were diagnosed with metastatic PCa with secondary bone deposits and were on androgen deprivation therapy (ADT). All participants were started on 4mg of zoledronic acid intravenously every 4 weeks for two years. The patients were reviewed every three months with full blood count, blood biochemistry, PSA and measurement of OC and CTX. Patients also underwent dental/oral examination. OC and CTX levels in serum were calculated using the ELISA method. RESULTS: A significant decrease in PSA levels was found (β=-0.06, SE=0.02, p=0.006). The levels of OC (β=-0.46, SE=0.14, p=0.001) and CTX (β=-0.01, SE=0.004, p=0.007) also decreased significantly during the two years of follow up. Osteonecrosis of the jaw was identified in three patients at two years. Patients with osteonecrosis also showed a decrease in OC and CTX levels. The mean OC reduction was 77.3% for patients with osteonecrosis and 12.6% for patients without osteonecrosis. The mean CTX reduction was 44.1% for patients with osteonecrosis and 9.62% for patients without osteonecrosis. CONCLUSION: Our study demonstrated no clear association between the levels of serum OC and CTX and bisphosphonate-related osteonecrosis of the jaw (BRONJ). To date, there is no clinically useful biomarker for the prediction of jaw osteonecrosis. More studies are needed using different bone turnover markers in order to identify patients at risk for BRONJ.
OBJECTIVE: To examine the predictive value of osteocalcin (OC) and C-terminal telopeptide (CTX) levels for jaw osteonecrosis in high-risk prostate cancer (PCa) patients taking bisphosphonates (BPs). METHODS: Twenty-four patients were prospectively recruited in this study and followed from 2011 to 2015. All patients were diagnosed with metastatic PCa with secondary bone deposits and were on androgen deprivation therapy (ADT). All participants were started on 4mg of zoledronic acid intravenously every 4 weeks for two years. The patients were reviewed every three months with full blood count, blood biochemistry, PSA and measurement of OC and CTX. Patients also underwent dental/oral examination. OC and CTX levels in serum were calculated using the ELISA method. RESULTS: A significant decrease in PSA levels was found (β=-0.06, SE=0.02, p=0.006). The levels of OC (β=-0.46, SE=0.14, p=0.001) and CTX (β=-0.01, SE=0.004, p=0.007) also decreased significantly during the two years of follow up. Osteonecrosis of the jaw was identified in three patients at two years. Patients with osteonecrosis also showed a decrease in OC and CTX levels. The mean OC reduction was 77.3% for patients with osteonecrosis and 12.6% for patients without osteonecrosis. The mean CTX reduction was 44.1% for patients with osteonecrosis and 9.62% for patients without osteonecrosis. CONCLUSION: Our study demonstrated no clear association between the levels of serum OC and CTX and bisphosphonate-related osteonecrosis of the jaw (BRONJ). To date, there is no clinically useful biomarker for the prediction of jaw osteonecrosis. More studies are needed using different bone turnover markers in order to identify patients at risk for BRONJ.
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Keywords:
Bisphosphonate-relatedzzm321990osteonecrosis of the jaw; Bone markers; C-terminal telopeptide; Cáncer de próstata; Marcadoreszzm321990óseos; Osteocalcin; Osteocalcina; Osteonecrosiszzm321990mandibular relacionada con bifosfonatos; Prostate cancer; Telopéptido C-terminal