Bisphosphonate-Related Osteonecrosis of the Jaw Risk Assessment

Patient Selection and Risk Stratification

• The American Dental Association recommends considering a drug holiday for patients with a CTX level < 150 pg/mL, as this threshold defines the "risk zone" for developing osteonecrosis after dentoalveolar surgery, with a 5.3-fold increased odds ratio for BRONJ development (P = 0.004) 1

Clinical Context and Extraction Protocol

• The American College of Surgeons suggests performing tooth extraction under local anesthesia with conservative surgical technique, prescribing perioperative antibiotics for 7 days, and considering perioperative chlorhexidine mouth rinses for patients with a CTX level of 293 pg/mL, indicating low risk for bisphosphonate-related osteonecrosis of the jaw (BRONJ) 1

CTX Testing and Interpretation

• The Endocrine Society notes that CTX values vary with multiple factors, including time of day, fasting status, renal function, and specific bisphosphonate type, with alendronate associated with lower CTX than risedronate, and CTX increases approximately 25 pg/mL per month after bisphosphonate cessation 1