Fluctuation of the type I collagen cross-linked C-telopeptide value in urine after withdrawal of bisphosphonates

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  • IWAMOTO Osamu
    Dental and Oral Medical Center, Kurume University School of Medicine
  • IWAYA Katsumi
    Dental and Oral Medical Center, Kurume University School of Medicine
  • TODOROKI Keita
    Dental and Oral Medical Center, Kurume University School of Medicine
  • KOBA Akihiro
    Dental and Oral Medical Center, Kurume University School of Medicine
  • KOGA Makoto
    Dental and Oral Medical Center, Kurume University School of Medicine
  • KUSUKAWA Jingo
    Dental and Oral Medical Center, Kurume University School of Medicine

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Other Title
  • ビスフォスフォネート製剤休薬による尿中 I 型コラーゲン架橋 C-テロペプタイド値の変動について
  • ビスフォスフォネート セイザイキュウヤク ニ ヨル ニョウチュウ Iガタ コラーゲン カケハシ C-テロペプタイドチ ノ ヘンドウ ニ ツイテ

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We previously reported that the measurement of type I collagen cross-linked C-telopeptide in urine （u-CTX） is useful for evaluating the risk of developing bisphosphonate （BP） -related osteonecrosis of the jaw （BRONJ）. In this study, we observed fluctuations of the u-CTX value after the withdrawal of BP.<br>The subjects were 84 patients who were using BP in whom the withdrawal of BP for 3 months was possible. The u-CTX value is expressed as the interquartile range （median ［25% point, 75% point］. The u-CTX value before withdrawal was 59.5 ［36.0, 99.8］ Cr value, and increased to 110.0 ［69.3, 161.5］ Cr value 3 months after withdrawal （p<0.001）. Although we previously presented the cutoff value （98 Cr value） of u-CTX as related to the risk of developing BRONJ, the u-CTX value in this study was lower than the 98 Cr value before withdrawal, and increased to a level higher than the 98 Cr value after withdrawal for 3 months in 35 （56.5%） of 62 patients in the oral administration group, as compared with only 1 （11%） of 9 patients in the injection administration group. Furthermore, this was noted in 19 （47%） of 40 patients in the steroid non-combined use group and only 6 （27%） of 22 patients in the combined use group. Forty-one patients with a u-CTX value of higher than 98 Cr did not develop BRONJ after an extraction. Of the 9 patients with a u-CTX value of less than 98 Cr, 3 developed BRONJ after an extraction.<br>These results suggest that improvement in the bone metabolic capacity, which was being suppressed by BP, can be detected by measuring the u-CTX value after the withdrawal of BP, and this value might be a useful index to judge the appropriate time for tooth extraction. However, it should be noted that the u-CTX values in patients who received BP injections or the combined use of steroids were low before withdrawal and did not readily increase even after withdrawal.

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