Perspective

Perspective: Assessing the Clinical Utility of Serum CTX in Postmenopausal Osteoporosis and Its Use in Predicting Risk of Osteonecrosis of the Jaw

Sanford Baim *, Paul D Miller

Colorado Center for Bone Research, Lakewood, Colorado, USA

^*Correspondence to Sanford Baim, Address reprint requests to: Sanford Baim, MD, FACR, CCD, Colorado Center for Bone Research, Suite 250, 3190 S. Wadsworth Boulevard, Lakewood, CO 80227, USA

Dr Baim has received scientific grants from Procter & Gamble, Sanofi-Aventis, Roche, Eli Lilly and Co., Merck, Novartis, and Amgen. Dr Miller has received scientific grants from Procter & Gamble, Sanofi-Aventis, Roche, Eli Lilly and Co., Merck, Novartis, and Amgen and is a consultant/speaker's board member for Procter & Gamble, Sanofi-Aventis, Merck, Eli Lilly and Co., Amgen, NPS, Novartis, Roche, and GlaxoSmithKline. Neither Dr Baim nor Dr Miller has an equity position in any pharmaceutical company.

Keywords

bone turnover markers • bone resorption • bisphosphonates • osteoporosis • osteonecrosis of the jaw

Abstract

Bone turnover markers (BTMs) have become increasingly important in the management of postmenopausal osteoporosis (PMO). In bisphosphonate-treated women with PMO, BTMs can provide early indications of treatment efficacy, are predictors of BMD response and fracture risk reduction, and are potentially useful for monitoring patient compliance. The bone resorption marker serum C-telopeptide cross-link of type 1 collagen (sCTX) has shown high sensitivity and specificity for the detection of increased bone resorption. Recently, sCTX has been singled out as a potential indicator of risk of osteonecrosis of the jaw (ONJ) in patients receiving oral bisphosphonates who require oral surgery. However, whether BTMs are capable of predicting ONJ risk and whether sCTX is usable for this purpose are controversial questions. This article presents an overview of the current literature regarding critical issues affecting the clinical utility of BTMs (including variability and reference ranges) and the current applications of BTMs in PMO management, with a focus on sCTX. Last, the appropriateness of using sCTX to predict ONJ risk in women receiving oral bisphosphonates for PMO is evaluated.

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Received: 10 December 2008; Revised: 16 January 2009; Accepted: 9 February 2009

Digital Object Identifier (DOI)

10.1359/jbmr.090203  About DOI