The aim of this study was to determine, in a clinical setting, the usefulness of bone metabolism markers of the typeⅠ collagen cross-linked N-telopeptide (NTX) test and the bone specific alkaline phosphatase (BAP) test in the development and management of anti-resorptive agents-related osteonecrosis of the jaw (ARONJ) in patients taking bisphosphonate (BP) and/or receptor activator of NF-κB ligand (RANKL) antibody. A total of 101 patients (osteoporosis: 64 cases, malignant tumor: 37 cases) underwent serum NTX and BAP measurements. The significant correlation between ARONJ and those bone metabolism markers was analyzed by logistic regression. As a result, the development of ARONJ was not correlated with any level of NTX, but was correlated with the lower level of BAP. BAP was suggested to be a significant factor affecting the development of ARONJ. The morbidity risk of ARONJ was high at less than 12.35μg/l of BAP, moderate between 12.35μg/l and 15.25μg/l, and low at more than 15.25μg/l. In cases of oral surgery such as tooth extraction and alveolar bone operation for patients taking BP and/or RANKL antibody, it is suggested that the value of BAP might be a very significant indicator of ARONJ development.
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