Morris Patrick G, Fazio Maurizio, Farooki Azeez, Estilo Cherry, Mallam Divya, Conlin Alison, Patil Sujata, Fleisher Martin, Cremers Serge, Huryn Joseph, Hudis Clifford A, Fornier Monica N
Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Oral Maxillofac Surg. 2012 Dec;70(12):2768-75. doi: 10.1016/j.joms.2011.12.028. Epub 2012 Feb 11.
Oversuppression of bone turnover can be a critical factor in the pathogenesis of osteonecrosis of the jaw (ONJ). We investigated N-telopeptide of type I collagen (NTX) and bone-specific alkaline phosphatase (BAP) as potential predictors of ONJ onset.
Patients with ONJ and available stored serum were identified retrospectively from the institutional databases. Four approximate points were examined: point of ONJ diagnosis and 12, 6, and 1 month before the diagnosis. NTX and BAP were measured using enzyme-linked immunosorbent assays and examined as possible predictors of ONJ.
From March 1998 to September 2009, we identified 122 patients with ONJ. Of these, 56 (46%) had one or more serum samples available. Overall, 55 patients (98%) received bisphosphonates. Using the exact dates, no obvious patterns in either NTX or BAP were noted. Similarly, using the ordinal points, no evidence of suppression of NTX or BAP over time was seen. The consecutive median values were as follows: The median NTX values were 8.0 nmol/L (range 3.8 to 32.9) at 12 months before ONJ; 9.5 nmol/L (range 4.7 to 42.7) at 6 months; 9.5 nmol/L (range 4.5 to 24.6) at 1 month, and 10.4 nmol/L (range 4.4 to 32.5) at the ONJ diagnosis. The median BAP values were BAP 18.0 U/L (range 7.0 to 74) at 12 months before ONJ; 18.0 U/L (range 4.0 to 134) at 6 months; 14.0 U/L (range 4.0 to 132) at 1 month, and 18.0 U/L (range 0.7 to 375) at the ONJ diagnosis. Only 2 patients (4%) had NTX and 17 (30%) had BAP below the normal range at the ONJ diagnosis.
In the present large retrospective study, no trends were seen in the NTX and BAP levels before the ONJ diagnosis.
骨转换过度抑制可能是颌骨骨坏死（ONJ）发病机制中的一个关键因素。我们研究了I型胶原N-端肽（NTX）和骨特异性碱性磷酸酶（BAP）作为ONJ发病潜在预测指标的情况。
通过机构数据库回顾性确定患有ONJ且有可用储存血清的患者。检查了四个大致时间点：ONJ诊断时间点以及诊断前12个月、6个月和1个月。使用酶联免疫吸附测定法测量NTX和BAP，并将其作为ONJ的可能预测指标进行检查。
从1998年3月至2009年9月，我们确定了122例ONJ患者。其中，56例（46%）有一份或多份可用血清样本。总体而言，55例患者（98%）接受了双膦酸盐治疗。使用确切日期，未发现NTX或BAP有明显变化模式。同样，使用顺序时间点，也未观察到NTX或BAP随时间受到抑制的证据。连续中位数如下：ONJ前12个月NTX中位数为8.0 nmol/L（范围3.8至32.9）；6个月时为9.5 nmol/L（范围4.7至42.7）；1个月时为9.5 nmol/L（范围4.5至24.6），ONJ诊断时为10.4 nmol/L（范围4.4至32.5）。ONJ前12个月BAP中位数为18.0 U/L（范围7.0至74）；6个月时为18.0 U/L（范围4.0至134）；1个月时为14.0 U/L（范围4.0至132），ONJ诊断时为18.0 U/L（范围0.7至375）。仅2例患者（4%）在ONJ诊断时NTX低于正常范围，17例患者（30%）BAP低于正常范围。
在本大型回顾性研究中，ONJ诊断前NTX和BAP水平未见趋势变化。
