CTx Test: Any Information?

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Dr. S. asks:

One of my elderly female patients needs dental implants and has been taking oral bisphosphonates for many years. I spoke with her physician and he recommended a CTX test. What is this test and what does it measure? Are any other dentists ordering this test? If so, can someone explain how I order this test and how I interpret the findings? Are there any good articles that explain this?

Thanks.

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9 Responses to “ CTx Test: Any Information? ”

• docf May 26th, 2008

  
  

  The CTx Test is short for: serum C-terminal telopeptide test. It is a medical blood test that is used to assess the risk of oral bisphosphonate-induced osteonecrosis of the jaws and guide treatment decisions.

  The test is performed by Quest Diagnostics and the patient must fast 12 hours beforehand.

  According to Marx ( J Oral Maxillofac Surg. 2007 Dec;65(12):2397-410.): “A stratification of relative risk was seen as CTX values less than 100 pg/mL representing high risk, CTX values between 100 pg/mL and 150 pg/mL representing moderate risk, and CTX values above 150 pg/mL representing minimal risk. The CTX values were noted to increase between 25.9 pg/mL to 26.4 pg/mL for each month of a drug holiday indicating a recovery of bone remodeling and a guideline as to when oral surgical procedures can be accomplished with the least risk.”

• SFOMS May 27th, 2008

  
  

  CTx is Serum C-terminal Telopeptide, crosslinked… a marker used to measure bone metabolism. It is a by-product of normal bone metabolism or bone turnover. In non-menopausal women, the normal value is “

• SFOMS May 27th, 2008

  
  

  Sorry for the multiple posts, but the less than sign is being a little screwy.

  CTx is Serum C-terminal Telopeptide, crosslinked… a marker used to measure bone metabolism. It is a by-product of normal bone metabolism or bone turnover. In non-menopausal women, the normal value is less than 250 - 4500 pmol/L, or less than 32 - 580 pg/mL”. Any major university hematology lab or special hemotological testing facility should be able to run this test. For consistent results, a fasting sample is recommended at similar times.

  Having a low value of CTx could mean that the bone turnover is low, thus less likely to recover from trauma, i.e. a tooth extraction or implant placement. The risk categories are listed above. 150 pg/mL is the guideline, if CTx is low, then discontinue the medication with physician approval and retest in 3 months. However, in random samples in the same patient, the value of CTx varied widely, so the accuracy of a sample may not be absolute. So this test is not an absolute necessity, just a guideline.

• Dr. Steven Fox May 27th, 2008

  
  

  I have had several patients undergo the test. They had been taking BP for 3-10 years. All came back low risk.

• YGC May 27th, 2008

  
  

  There is no evidence that oral bisphosphonate induces bone necrosis after dental implant placement. Also the criteria in the article published in Journal of Oral and Maxillofacial Surgery. 2007 Dec;65(12):2397-410. is not supported by scientific data. The scientific flaws of the article is also mentioned in the editorial in J Oral & Maxillofac Implants. 2008;24 :179-80.

• Dr. Michael Downie May 27th, 2008

  
  

  We have 2 patients in our practice who: had dental implants placed, had subsequent osteonecrosis, and only risk factor was 5 years of oral Fosamax. Only 2 cases, but I became a ‘believer’ in the possibility rather than a practitioner in ‘denial’.

• Bob May 28th, 2008

  
  

  The Least Significant Change for Bone Resorption Markers like the CTX is 60-80% even if all test parameters (morning fasting, same lab etc.) are controlled properly. As long as test results vary this much we should not fool ourselves or our patients with “safe” or “unsafe” CTX-Levels. The working mechanism of bisphosphonates on a molecular basis is only partly understood and we know even less about the molecular mechanisms leading to ONJ. At this point we just don`t have accurate tools to precisely access the very low risk of ONJ due to oral Bisphosphonates. The Task Force Report of the American Society of Bone and Mineral Research on the Bisphosphonate/ONJ issue does not mention CTX levels at all.

• mike May 29th, 2008

  
  

  Not all return high I just had one come back 67 from 2 years of boniva If you place implants in these patients on Bisphos, I hope you have good malpractice coverage. Don’t you guys watch TV This is the attorney’s next harvest crop. I suggest you proceed with utmost caution and intense consent and documentation if you do However we all know that doesn’t keep us out of the courtroom.
  Marx’s data is all we have now to go on and I think this will be the protocal for any defense for complications.

• Dr. Mehdi Jafari May 30th, 2008

  
  

  I sincerely invite everybody to use the following link:
  http://www.osseonews.com/ctx-level-what-level-is-risky/
  Thanks.

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