{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:47:38Z","timestamp":1790189258985,"version":"4.1.0"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>Our aim was to determine serum C-terminal telopeptide of type I collagen (sCTX) thresholds for predicting the minimal risk of medication-related osteonecrosis of the jaw (MRONJ) in patients undergoing anti-resorptive therapy prior to oral surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A systematic literature search was conducted in MEDLINE, EMBase, and the Cochrane Library up to September 2023 for case-control, prospective and retrospective studies that assessed sCTX levels in patients exposed to anti-resorptive drugs who underwent oral surgery. We extracted data using a predetermined form. We performed an original percentile meta-analysis method, following PRISMA-DTA guidelines and descriptive analysis to identify the threshold associated with the lowest risk while assessing the overall result of the 95<jats:sup>th<\/jats:sup>, 97.5<jats:sup>th<\/jats:sup> and 99<jats:sup>th<\/jats:sup> percentiles with a random-effect model with weighting by DerSimonian and Laird (RStudio software [v. 4.2.0]).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Seven studies involving 1281 patients were included. Most patients (96%) were treated for osteoporosis, predominantly with oral bisphosphonates (94.5%). Individual data were available for 58 patients. In the entire population of patients who experienced MRONJ after oral surgery (n\u2009=\u2009113), the 95<jats:sup>th<\/jats:sup>, 97.5<jats:sup>th<\/jats:sup> and 99<jats:sup>th<\/jats:sup> percentiles of sCTX were 338.0 pg\/mL [95%CI: 190,3; 485,7], 401.9 pg\/mL [95%CI: 191,3; 612,6], and 458.0 pg\/mL [95%CI: 190,4; 725,6], respectively.<\/jats:p>\n<jats:p>Among those treated with oral bisphosphonates for osteoporosis (n\u2009=\u200938), the sCTX 95<jats:sup>th<\/jats:sup>, 97.5<jats:sup>th<\/jats:sup> and 99<jats:sup>th<\/jats:sup> percentiles were 185.3 pg\/mL [95%CI: 131,3; 239,3] 187.4 pg\/mL [95%CI: 133,9; 240,8] and 188.6 pg\/mL [95%CI: 135,4; 241,9], respectively. The determination of these same percentiles with individual data analysis yielded similar results, i.e., 202.0, 257.0 and 260.0 pg\/mL.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This pioneering meta-analysis assesses the risk of MRONJ by analyzing sCTX levels in patients undergoing oral surgery while exposed to antiresorptive drugs. Among patients receiving oral bisphosphonate therapy for osteoporosis, a sCTX threshold of 260 pg\/mL is linked to an extremely low risk of MRONJ occurrence, surpassing the 99<jats:sup>th<\/jats:sup> percentile. Conversely, for patients undergoing treatment for cancer-related conditions, sCTX levels do not reliably serve as a biomarker for identifying this risk.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0318260","type":"journal-article","created":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T17:29:29Z","timestamp":1746466169000},"page":"e0318260","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Identifying a predictive level of serum C-terminal telopeptide associated with a low risk of medication-related osteonecrosis of the jaw secondary to oral surgery: A systematic review and 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