Jaw Osteoradionecrosis

Q: Dr. Eppley, I am a 55 year old female who was on the oral bisphosphonate, Actonel, for about 5 years. I last took this medication about 5 years ago. I had a CTX test done in October (level was 215), because I was contemplating jaw surgery to correct a midline issue. Neither local oral surgeons who I consulted with felt comfortable doing the surgery for cosmetic purposes. I have since gotten into braces to correct the issue. My concern with genioplasty is whether the same risk level is present for osteonecrosis as exists with jaw surgery. Any thoughts would be appreciated.

A: Since the chin is part of the jaw, the same potential risks exists for it as any other part of the jaw for bisphosphonate patients in regards to developing jaw osteoradionecrosis from a surgical insult. Poor bone healing has been reported for genioplasty on bisphosphonate patients

However, the CTX (serum C-terminal telopeptide) blood test is used as a predictor of that risk which assesses how well the bone can remodel and heal. The risk stratification is seen as high risk at less than 100, moderate risk between 100 to 150 and minimal risk above 150. It is also known that the longer one is off the drug the CTX values will increase at a rate 1/month. This explains your favorable CTX value five or more years off the drug.

While no one can say that your  jaw osteoradionecrosis risk is zero, it would be considered minimal at this point.

Dr. Barry Eppley
Indianapolis, Indiana