ArticleJournal of clinical and experimental dentistry2026
Osteocalcin and C-terminal telopeptide of type I collagen in serum and saliva: A cross-sectional pilot study on correlations and implications for MRONJ risk stratification in women on antiresorptive medications.
Article in Journal of clinical and experimental dentistry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) lacks reliable biomarkers for early detection in patients receiving antiresorptive therapy. The objective is to evaluate serum and salivary C-terminal telopeptide of type I collagen (CTX) and osteocalcin (OC) as tools to differentiate healthy controls, MRONJ at-risk patients, and those with MRONJ clinically present. Materials and Methods: Cross-sectional pilot study of 30 females categorized into controls (n=10), MRONJ at-risk (n=9), and MRONJ clinically present (n=11). Serum and unstimulated saliva were analyzed by ELISA. Statistical analyses included ANCOVA with age as covariate, Dunn post-hoc test with Bonferroni correction, and bootstrapped ROC curves (1,000 iterations). Results: After age adjustment, serum OC was a significant independent predictor of group status (p=0.002), as was salivary OC (p=0.045). Post-hoc analysis showed serum OC was significantly higher in the MRONJ at-risk group versus controls (Bonferroni-adjusted p=0.030) and MRONJ clinically present (adj p=0.012). Serum CTX did not reach significance after Bonferroni correction (p=0.183). Serum OC achieved the highest discriminatory performance (AUC=0.88, 95% CI: 0.70-1.00; 100% sensitivity at <4,801 pg/mL). No significant associations were found between biomarkers and medication duration or trigger type. Conclusions: Serum OC is a promising adjunctive biomarker for MRONJ risk stratification, maintaining diagnostic significance after age adjustment. Serum-salivary correlations suggest noninvasive monitoring potential, though serum remains the more reliable measurement medium. While the proposed cutoff (<4,801 pg/mL) serves as a valuable preliminary reference, it remains exploratory and warrants external validation in larger prospective cohorts prior to clinical application.
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