Impact of Preventive Dental Management on MRONJ Development in Multiple Myeloma: A Prospective Study with CTX Evaluation

Aim: Medication-related osteonecrosis of the jaw (MRONJ)
is a clinically significant complication associated with
bisphosphonate therapy in patients with multiple myeloma.
Preventive dental strategies are recommended to reduce this
risk; however, the role of biochemical markers such as serum
C-terminal telopeptide (CTX) in predicting MRONJ remains
controversial. This study aimed to evaluate the impact of
preventive dental management on MRONJ development in
patients with multiple myeloma receiving bisphosphonate
therapy and to assess the relationship between serum CTX
levels and MRONJ occurrence.
Material and Method: This prospective study included 50
patients with multiple myeloma who were followed between
February 2009 and April 2010. Twenty-five newly diagnosed
patients underwent serum CTX measurement and comprehensive
dental examination prior to initiation of bisphosphonate therapy.
When dental risk factors were identified, bisphosphonate
treatment was postponed until completion of necessary dental
interventions. The study also included 25 previously diagnosed
patients who had already been receiving bisphosphonate
therapy without systematic preventive dental evaluation. Serum
CTX levels were measured using the Elecsys β-CrossLaps assay,
and their association with MRONJ development was analyzed.
Results: No cases of MRONJ were observed in the newly
diagnosed group who underwent preventive dental evaluation
prior to bisphosphonate initiation. In contrast, MRONJ occurred
in 24% of patients in the previously treated group without
preventive dental management. Patients who developed
MRONJ tended to have lower serum CTX levels compared
with those who did not develop osteonecrosis; however, this
difference was not statistically significant. Accordingly, CTX
values did not demonstrate sufficient discriminatory capacity
to serve as an independent predictive biomarker.
Conclusion: Preventive dental examination and appropriate
dental management prior to bisphosphonate therapy appear to
be effective strategies for reducing MRONJ risk in patients with
multiple myeloma. Although lower CTX levels were observed
in patients who developed MRONJ, serum CTX alone does not
provide sufficient predictive value for MRONJ risk assessment.