In reply

Abstract

The American Society for Bone and Mineral Research (ASBMR) task force argues that the 30-patient C-terminal telopeptide testing we accomplished is opinion rather than evidence. Indeed, it is evidence as the photographs and the statistical correlations attest. This may be an uncomfortable truth for them because it contrasts sharply with the ASBMR position paper, which makes the profound recommendation that “it is not necessary to recommend a dental examination before beginning oral bisphosphonate therapy or to otherwise alter routine dental management” based on absolutely no evidence whatsoever, but merely the opinions of the task force members. The readers of the Journal of Oral and Maxillofacial Surgery should be aware that of the 23 authors of the ASMBR position paper, they disclose that 12 (52%) are paid consultants of Novartis, 7 (30%) are paid consultants of Merck, and 6 (26%) are paid consultants of Amgen or Proctor & Gamble Pharmaceuticals. All these companies make antiresorptive drugs that treat osteoporosis and also cause osteonecrosis of the jaws (ONJ). Many of the task force members have also received large research grants from these companies. Therefore, their criticisms may be viewed as more parochial than scientific. Because bisphosphonate-induced ONJ is a rare but very real entity, large studies are not possible. However, our testing of 30 cases in this article and 14 more in the meantime continues to show the same results. It is certainly more evidence than the ASBMR has produced and is certainly independent of any support from drug companies. Oral Bisphosphonate–Induced Osteonecrosis: Risk Factors, Prediction of Risk Using Serum CTX Testing, Prevention, and TreatmentJournal of Oral and Maxillofacial SurgeryVol. 66Issue 6PreviewIn their article “Oral Bisphosphonate-Induced Osteonecrosis: Risk Factors, Prediction of Risk Using Serum CTX Testing, Prevention, and Treatment,” Marx et al1 proposed using serum C-telopeptide (CTX) as a tool to “assess risks and guide treatment decisions” in the management of osteonecrosis of the jaw (ONJ) in the setting of oral bisphosphonate therapy. Unfortunately, the data presented in their article, although showing a low CTX value in a cohort of patients with ONJ, do not support their recommendations for monitoring CTX levels to make treatment decisions. Full-Text PDF