Alteration of bone metabolic markers such as urine CTX and blood P1NP after discontinuing administration of bisphosphonates at the time of tooth extraction in patients with osteoporosis

DOI
  • HASEGAWA Tomonori
    Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine
  • WAKUI Takahiro
    Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine Section of Dentistry, Oral and Maxillofacial Surgery, Kamitsuga General Hospital
  • KOMIYAMA Yuske
    Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine
  • SAITO Masahiro
    Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine Section of Dentistry, Oral and Maxillofacial Surgery, Kamma Memorial Hospital
  • UCHIDA Daisuke
    Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine
  • KAWAMATA Hitoshi
    Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine

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Other Title
  • 骨粗鬆症患者の抜歯時におけるビスフォスフォネート製剤休薬による骨代謝マーカー（尿中CTX値・血中P1NP値）の変動

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Abstract

Position papers regarding medication-related osteonecrosis of the jaw have not clearly addressed whether discontinuing the administration of bisphosphonates （BPs） can prevent the occurrence of osteonecrosis of the jaw. In this study, we measured bone metabolic markers, such as C-terminal telopeptide （CTX） in the urine and procollagen type 1 N-terminal propeptide （P1NP） in the blood, during tooth extraction procedures, and evaluated the recovery of bone metabolism after discontinuing the administration of BPs. Before tooth extraction, we queried the patients’ medical doctors whether discontinuing administration of BPs was possible. After consulting with the doctors, 21 patients with osteoporosis were enrolled in this study to measure their bone metabolic markers after discontinuing the administration of BPs for 6 months. Between 2008 and 2014, these patients underwent tooth extraction in our department according to our protocol to prevent the occurrence of osteonecrosis of the jaw. Bone metabolism markers were measured before discontinuing the drug, immediately before tooth extraction （approximately 3 months after BP withdrawal）, and 3 months after tooth extraction （approximately 6 months after BP withdrawal）. During the procedures, urine CTX levels slightly increased, although they did not reach significant levels at 3 months （p=0.36） or at 6 months （p=0.20）. Blood P1NP levels slightly increased at 3 months （p=0.17） after discontinuing the drug. The increase in blood P1NP levels reached a significant level at 6 months （p=0.01）. These results suggest that bone metabolism may recover after discontinuing the administration of BPs for 3 or 6 months in patients with osteoporosis in at least a static condition.

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