Utility of biomarkers in predicting the development of medication-related osteonecrosis of the jaws: A scoping review

Introduction: Medication-related osteonecrosis of the jaws (MRONJ) is a severe reaction consisting of progressive destruction of maxillofacial bone tissue caused mainly by antiresorptive and antiangiogenic drugs. The aim of this scoping review is to identify biomarkers that can predict the development of MRONJ in patients undergoing dental treatment. Methods: A scoping review was performed, using PubMed/MEDLINE, Web of Science and Scopus databases using the search formula with MesH terms: "((((("Bisphosphonate-Associated Osteonecrosis of the Jaw"[Mesh]) OR "Osteonecrosis"[Mesh]) AND "Maxilla"[Mesh]) OR "Mandible"[Mesh]) AND "Oral Surgical Procedures"[Mesh]) OR "Surgery, Oral"[Mesh]". Inclusion and exclusion criteria were applied for article selection. Results: We found 113 articles and screened 80 publications. After, 30 manuscripts remained for full -text evaluation. Twenty were discarded for not being related to the proposed objectives, leaving 9 articles included for qualitative analysis. Discussion: Several biomarkers considered as possible predictors of MRONJ development were found: bone alkaline phosphatase (BAP), parathyroid hormone (PTH), osteocalcin (OC), procollagen type 1 amino terminal propeptide (P1NP), N -terminal telopeptide of collagen type I (NTX), interleukin 6 (IL -6), deoxypyridinoline (DPD), 25 hydroxyvitamin D (25OHD), creatinine and total calcium, white blood cells (WBC), serum albumin (ALB), hemoglobin (HB), total cholesterol (CHL), C-reactive protein (CRP) and serum alkaline phosphatase (ALP). The most evaluated was C -terminal telopeptide of collagen type I (CTX). Conclusion: The use of predictive biomarkers would represent, for the population consuming drugs associated with osteonecrosis of the jaws, an advance and improvement in the planning of appropriate treatments and in their quality of life. Currently, it has not yet been possible to establish one or more specific biomarkers capable of predicting the development of MRONJ.