J Biol Regul Homeost Agents. 2021 May-Jun;35(3 Suppl. 1):219-227. doi: 10.23812/21-3supp1-25.

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Qualitative and quantitative analysis of the CTX in relation to the period of intake of bisphosphonates: A systematic review

Milani M1, Manenti RJ1, Marcattili D1, Marino R1, Lomurno AP1.

Author information

1  Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy.


The aim of this systematic review was to determinate the true value of C-terminal crosslinking telopeptide test (CTX) in patient who takes Bisphosphonate. A comprehensive search of studies published up to March 2020 and listed in the PubMed/MEDLINE and Cochrane Library databases, was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. The search identified 99 publications; 6 studies were finally deemed eligible for inclusion according to the study criteria. These studies included a total 104 patients and was selected 101. The CTX value in the various study groups is less than 150 pg/ml. There is a difference between the age of the patient and the period of taking the drug. This systematic review indicates that the CTX test has diffent predictive value in determining the risk of osteonecrosis in patients taking bisphosphonate compared to previus standard.


C-terminal crosslinking telopeptide test (CTX), bisphosphonate-related osteonecrosis of the jaw (BRONJ), ostenecrosis

Publication type

  • Systematic Review

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