Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
August 20, 2026 · via Europe PMC
Is C-Terminal Telopeptide Associated With Medication-Related Osteonecrosis of the Jaw Risk Following Extraction in Osteoporosis Patients Treated With Denosumab?
Yu E, Colella A, Sambrook P, Goss A.
AI summary — for doctors, generated from the abstract only
Among osteoporosis patients on denosumab undergoing dental extraction, lower CTX levels and more teeth extracted were associated with higher MRONJ risk.
What was studied
A prospective cohort of 314 denosumab-treated osteoporosis patients undergoing extraction with preoperative CTX measurement at an Australian centre (2017-2023).
Key findings
- MRONJ developed in 9 patients (2.9%), median 6.6 months after extraction
- Each unit increase in CTX was associated with slightly reduced risk (HR 0.99)
- Each additional tooth extracted increased risk by about 25% (HR 1.25)
- 7 of 9 cases had CTX below the cohort mean
Clinical relevance
CTX may contribute to risk assessment, but very few events limit reliability and the analyses were univariate.
Who should care
Limitations
Only 9 events; univariate analysis; 31% of eligible patients included.
Lower bone turnover and multiple extractions may raise jaw osteonecrosis risk on denosumab.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
The association between bone turnover, measured by C-terminal telopeptide (CTX), and medication-related osteonecrosis of the jaw (MRONJ) following dental extraction in denosumab-treated osteoporosis patients is not well characterized.
Purpose
To evaluate the association between preoperative CTX and time to MRONJ development following dental extraction in patients receiving denosumab for osteoporosis.
Study design, setting, sample
A prospective cohort study was conducted at a tertiary oral and maxillofacial surgery center in Australia (2017 to 2023). Patients receiving denosumab 60 mg for osteoporosis who underwent dental extraction with preoperative fasting CTX measurement were included. Patients with metastatic disease, metabolic bone disorders, prior head and neck radiotherapy, or current bisphosphonate therapy were excluded.
Predictor variable
Bone turnover measured using preoperative fasting serum CTX level relative to 150 ng/L and the cohort mean.
Main outcome variable
Time to MRONJ following dental extraction.
Covariates
Age, sex, comorbidity status, number of teeth extracted, and timing of CTX relative to the last denosumab dose.
Analyses
Group comparisons used χ2 and Student's t-tests. Time-to-event analysis used Kaplan-Meier estimates and Cox proportional hazards regression (P < .05).
Results
Of 1,020 eligible subjects, the sample was composed of 314 (31%) subjects with mean age of 76.2 ± 8.7 years and 253 (81%) were female. MRONJ developed in 9 subjects (2.9%), with an incidence of 0.056 per person-year of follow up (95% CI, 0.029 to 0.108) and median time to diagnosis of 6.6 months (interquartile range, 3.6 to 9.0). Mean CTX was 216.6 ng/L, and 210 subjects (67%) were below this level, including 7 of 9 MRONJ cases. In univariate Cox regression, each unit increase in CTX was associated with a 0.81% reduced MRONJ risk (hazard ratio, 0.99; 95% CI, 0.98 to 1.00; P = .045), and each additional tooth extracted was associated with a 24.8% increase in MRONJ risk (hazard ratio, 1.25; 95% CI, 1.02 to 1.53; P = .031).
Conclusion and relevance
Lower CTX levels and greater number of extractions were associated with increased risk for developing MRONJ among patients with osteoporosis treated with denosumab who require dental extractions.
DOI
10.1016/j.joms.2026.08.007
PMID
42686106
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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