Bassel Traboulsi-Garet1, Adrià Jorba-García1, Octavi Camps-Font1,2, Fabio Abreu Alves3, Rui Figueiredo4,5, Eduard Valmaseda-Castellón1,2. 1. Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Campus de Bellvitge, C/ Feixa Llarga, s/n; Pavelló Govern, despatx 2.9., 08907 , L'Hospitalet de Llobregat, Barcelona, Spain. 2. IDIBELL Institute, Barcelona, Spain. 3. Stomatology Department - A.C. Camargo Cancer Center, Sao Paulo, Brazil. 4. Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Campus de Bellvitge, C/ Feixa Llarga, s/n; Pavelló Govern, despatx 2.9., 08907 , L'Hospitalet de Llobregat, Barcelona, Spain. ruibarbosa@ub.edu. 5. IDIBELL Institute, Barcelona, Spain. ruibarbosa@ub.edu.
Abstract
OBJECTIVE: To determine the usefulness of Serum C-terminal telopeptide cross-link of type 1 collagen (sCTX) as a preoperative marker for predicting the risk of developing medication-related osteonecrosis of the jaws (MRONJ) after invasive oral surgery in patients on antiresorptive medication. MATERIALS AND METHODS: Two authors independently searched four electronic databases up to March 25, 2021, for case-control studies and prospective and retrospective cohort studies that assessed preoperative sCTX levels in patients taking antiresorptive medication who underwent oral surgery procedures. The main outcome was the number of MRONJ cases in patients with an sCTX value lower and higher than 150 pg/mL. Qualitative and quantitative data was extracted in tables and the risk of bias was assessed using the QUADAS-2 tool. Estimates of diagnostic accuracy were expressed as sensitivity, specificity, negative and positive likelihood ratio (LR - and LR +), and diagnostic odds ratio (DOR), with a 95% confidence interval (95%CI). The data were combined using random-effects models based on the inverse variance method. RESULTS: Seven studies were included in the meta-analysis. The results were as follows: sensitivity 57% (95%CI: 41-71%), specificity 72% (95%CI: 64-79%), LR + 2 (95%CI: 1.3-3.1), LR - 0.6 (95%CI: 0.4-0.9), and DOR 3.4 (95%CI: 1.5-7.7). CONCLUSIONS: The low overall performance of sCTX indicates that this parameter is not suitable for predicting MRONJ risk in patients on antiresorptive medication who need an oral surgery procedure. CLINICAL RELEVANCE: sCTX should not be considered a reliable preoperative marker to predict MRONJ development.
OBJECTIVE: To determine the usefulness of Serum C-terminal telopeptide cross-link of type 1 collagen (sCTX) as a preoperative marker for predicting the risk of developing medication-related osteonecrosis of the jaws (MRONJ) after invasive oral surgery in patients on antiresorptive medication. MATERIALS AND METHODS: Two authors independently searched four electronic databases up to March 25, 2021, for case-control studies and prospective and retrospective cohort studies that assessed preoperative sCTX levels in patients taking antiresorptive medication who underwent oral surgery procedures. The main outcome was the number of MRONJ cases in patients with an sCTX value lower and higher than 150 pg/mL. Qualitative and quantitative data was extracted in tables and the risk of bias was assessed using the QUADAS-2 tool. Estimates of diagnostic accuracy were expressed as sensitivity, specificity, negative and positive likelihood ratio (LR - and LR +), and diagnostic odds ratio (DOR), with a 95% confidence interval (95%CI). The data were combined using random-effects models based on the inverse variance method. RESULTS: Seven studies were included in the meta-analysis. The results were as follows: sensitivity 57% (95%CI: 41-71%), specificity 72% (95%CI: 64-79%), LR + 2 (95%CI: 1.3-3.1), LR - 0.6 (95%CI: 0.4-0.9), and DOR 3.4 (95%CI: 1.5-7.7). CONCLUSIONS: The low overall performance of sCTX indicates that this parameter is not suitable for predicting MRONJ risk in patients on antiresorptive medication who need an oral surgery procedure. CLINICAL RELEVANCE: sCTX should not be considered a reliable preoperative marker to predict MRONJ development.
Keywords:
Bisphosphonate-associated osteonecrosis of the jaw; Bone turnover markers; CTX; Jaw diseases; Medication-related osteonecrosis of the jaw; Osteonecrosis
Authors: Vittorio Moraschini; Daniel Costa Ferreira de Almeida; Carlos Marcelo Figueredo; Monica Diuana Calasans-Maia Journal: Oral Surg Oral Med Oral Pathol Oral Radiol Date: 2019-02-26