I read the May JADA article by Drs. Beatrice Edwards and Cesar Migliorati, "Osteoporosis and Its Implication for Dental Patients" (
JADA 2008:139[5]: 545–552[Abstract/Free Full Text]
) and commend the authors for their review on this timely subject.
In their article, the authors state that "a collaborative effort between dentists and physicians in deciding on the patient’s dental treatment is recommended." Unfortunately, they believe there are no scientific data to support the use of the serum C-telopeptide test of type I collagen (CTX), until more scientific research on the issue supports use of the CTX laboratory test.
Obviously, the test was developed to measure certain valuable information about the patient. Bisphosphonates are used increasingly to treat osteoporosis by reducing osteoclastic activity. Bone resorption is inhibited, which increases bone density. CTX is a measure of bone resorption, obviously in the total body as the authors state.
While collaboration is valuable, no other routine objective test is available to us to measure whether bisphosphonate medications used to treat osteoporosis are in fact reversing os-teoclastic turnover rates. CTX values of greater than 150 picograms per milliliter may show little need to discontinue bisphosphonate therapy to proceed with dental surgical procedures. Values less than 150 pg/mL suggest a greater risk of developing bisphosphonate-related osteonecrosis of the jaws1,2 and, I believe, would lead to increase the collaboration the authors underscore.
I endorse the call for more research in this area. I also believe that when an objective measure of certain parameters is available—in this case a clinical laboratory test that any dentist can order—and is not used, then increased and unnecessary patient morbidity possibly is the unfortunate result.
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