American Association of Oral and Maxillofacial Surgeons Position Paper on Medication-Related Osteonecrosis of the Jaw—2014 Update and CTX

Abstract

The “American Association of Oral and Maxillofacial Surgeons Position Paper on Medication-Related Osteonecrosis of the Jaw—2014 Update” (J Oral Maxillofac Surg 72:1938, 2014) is commendable for its review of the latest research, as well as for its recommendations on diagnosis, staging, and treatment of medication-related osteonecrosis of the jaw (MRONJ). My one criticism is that the authors have pointedly omitted mention of 3 letters: CTX. When one reads the text carefully, one finds that “the efficacy of using a systemic marker of bone turnover to assess the risk of developing jaw necrosis in patients at risk has not been validated” and “is not recommended.” It is true that many biomarkers of bone resorption are available; however, only the c-terminal cross-linking telopeptide (CTX) has been advocated in the Journal. Only the serum CTX level is routinely used by many of our colleagues before surgery in at-risk patients. Currently, no convincing scientific evidence has been presented for the usefulness of CTX in assessing the risk of MRONJ. I do not understand why the authors chose not to state this clearly in an otherwise excellent review. The practicing clinician deserves to find recommendations regarding CTX in both the abstract and the section on management strategies. Bisphosphonate Therapy: C-Terminal Telopeptide Testing Facilitates Devising More Accurate Consent for ExtractionJournal of Oral and Maxillofacial SurgeryVol. 73Issue 3PreviewThe authors of a recent publication in the Journal evaluated the C-terminal telopeptide (CTX) levels of a very large number of study subjects (n = 950), who received bisphosphonate medication orally for osteoporosis, and medically naive controls (n = 950).1 They have convincingly demonstrated a number of salient points, which have significant informed consent implications. Full-Text PDF Reply by the AuthorsJournal of Oral and Maxillofacial SurgeryVol. 73Issue 3PreviewI thank Drs Schwartz and Friedlander et al for their insightful comments regarding the 2014 American Association of Oral and Maxillofacial Surgeons (AAOMS) guidelines for the use of a C-terminal telopeptide (CTX) level as a predictor of medication-related osteonecrosis of the jaw (MRONJ). I have chosen to address their comments in a single reply. Although Dr Schwartz suggested a more forceful and frequent denunciation of the CTX test, Friedlander et al proposed just the opposite and would rather we consider this test as an osteonecrosis of the jaw (ONJ) risk assessment tool. Full-Text PDF