Background : Bone biomarkers have been suggested for the risk assessment for osteonecrosis of the jaw, a serious complication associated with bisphosphonate (BP) use; however, no consensus has been reached. This study investigated the possible associations between bone biomarkers and the development of bisphosphonates-related osteonecrosis of the jaw (BRONJ).

Methods : This is a case-control study of 37 patients with BRONJ (age, 73.6 ± 11.2 years) and age- and gender-matched controls who had been exposed to BPs for >24 months but had no evidence of BRONJ after dentoalveolar surgery. The association between biomarkers (osteocalcin [OC], deoxypyridinoline [DPD], C-terminal telopeptides [CTX], N-terminal telopeptides [NTX], bone-specific alkaline phosphatase [BAP], and parathyroid hormone [PTH]) and BRONJ development, the effects of drug holiday on biomarkers, and the performance of biomarkers for risk assessment were investigated.

Results : The PTH levels were significantly different between the 2 groups ( P < 0.05), but not the OC, DPD, CTX, NTX, and BAP levels ( P > 0.05). Among BRONJ patients who discontinued BP, in a linear mixed model, only CTX showed a significant increase over time ( ß = 0.002, P = 0.007). The cutoff PTH level was >41.52 pg/mL (AUC = 0.719, P = 0.009), and that of CTX was = 0.094 ng/mL (AUC = 0.619, P = 0.069).

Conclusion : There is insufficient evidence for the risk prediction for BRONJ of bone biomarkers. Low biomarker values confirmed by continuous checkups may signal risks; however, BRONJ risk should not be determined on the basis of a single result before dentoalveolar surgery.