Bone turnover and inflammatory markers of bisphosphonate-related osteonecrosis of the jaw in female osteoporosis patients

ObjectiveThis study aimed to analyze the difference in biochemical markers of patients with osteoporosis taking bisphosphonates (BPs) who developed bisphosphonate-related osteonecrosis of the jaw (BRONJ) vs those who did not develop BRONJ.Patients & methodsForty-one BRONJ patients and 76 control patients who had been treated with alendronate or risedronate were investigated. Bone turnover markers [C-terminal telopeptide (CTX) and bone-specific alkaline phosphatase (bALP)] and inflammatory activity markers [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level] were evaluated. In BRONJ patients, radiographic severity and its relation with the serological data and BRONJ staging were analyzed.ResultsCTX and bALP level after the long-term BPs treatment in the control patients was similar to the level of the BRONJ patients at the time of diagnosis. The BRONJ patients showed a significantly higher ESR than the control patients with BPs. BRONJ score were not correlated with CTX and bALP. The severity of BRONJ in alendronate-treated group was strongly correlated with ESR and CRP.ConclusionsBone turnover markers such as serum CTX level has limitation in reflecting BRONJ status. Increased level of inflammatory markers in BRONJ patients implies the importance of inflammation in BRONJ progression.