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.
4 affiliations
- 1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand.
- 2Faculty of Dentistry, Burapha University, Chonburi, 20131, Thailand.
- 3Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand.
- 4Department of Oral, Maxillofacial and Facial Plastic Surgery, Sana Klinikum, Starkenburgring 66, Offenbach am Main, Germany.
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.
Related
- A Literature Review on the Waist Circumference Criteria for Metabolic Syndrome in Japan: Evidence and Implications for Cardiovascular Risk Stratification
- Inflammation After Transcatheter Aortic Valve Implantation: Mechanisms, Risk Stratification, and Therapeutic Implications
- Crosstalk mechanisms, clinical correlations and therapeutic implications linking OSA with HFpEF progression
- Associations Between Serum Osteocalcin and Metabolic, Nutritional, and Hormonal Status in Male Patients with Chronic Kidney Disease: A Cross-Sectional Study
- Plasma proteomic signatures in bipolar disorder and their implications for data-driven patient stratification
BibTeX
@article{puntrakul2026osteocalcin,
title = {{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.}},
author = {Chitsanupong Puntrakul and Nakarin Kitkumthorn and Puangwan Lapthanasupkul and Constantin Landes and Chakorn Vorakulpipat},
journal = {Journal of clinical and experimental dentistry},
year = {2026},
month = aug,
doi = {10.4317/jced.64415},
url = {https://europepmc.org/article/MED/42894835},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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.
AU - Chitsanupong Puntrakul
AU - Nakarin Kitkumthorn
AU - Puangwan Lapthanasupkul
AU - Constantin Landes
AU - Chakorn Vorakulpipat
PY - 2026
DA - 2026/08/28
JO - Journal of clinical and experimental dentistry
DO - 10.4317/jced.64415
UR - https://europepmc.org/article/MED/42894835
AB - 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.
SN - 1989-5488
ER -