Role of the CTX Test for Evaluation of the Risk in Diagnostic and Treatment of the Osteonecrosis of the Jaws Induced by the use of Bisphosphonates
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A literature review was conducted to determine the effectiveness of the C-terminal crosslinking telopeptide (CTX) serologic test, which has been suggested to predict the risk of developing osteonecrosis of the jaw in patients taking oral bisphosphonates. Osteonecrosis of the jaw (ONJ) is a condition that causes avascular necrosis of the alveolar bone, which occurs in patients treated with bisphosphonates. It has been suggested that a CTX value below 100 pg/ml represents a high risk for ONJ , while between 100 and 150 pg / ml a moderate risk and above 150pg/ml minimal risk. The CTX test has been controversial and it has not been possible to frame it as strong evidence, since several studies have found variable results. Patients with very low CTX levels have not developed ONJ, and others with very high CTX levels, supposedly safe, have done . CTX test is a useful test to inform the dentist about the activity level on patient ́s bone turnover, and may be useful to advise the patient. Low CTX levels could serve to delay a surgical procedure that is not deemed urgent.
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