Bone-formation-related markers in osteonecrosis of the jaws and their correlation with radiographic findings.

Purpose: To evaluate serum levels of the bone-formation-related markers sclerostin and alkaline phosphatase (ALP) in patients with medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN), and to identify a correlation with radiographic findings.

Methods: A cross-sectional study was conducted with osteonecrosis patients [MRONJ (n = 11); ORN (n = 21)] compared with individuals without osteometabolic diseases (control group, CG n = 27). Serum levels of sclerostin (pg/ml) and ALP (U/L) were evaluated. Gray-level pixel intensity (mean-Mgv and standard deviation-SDgv), fractal dimension (FD), and lacunarity (Lac) in the necrotic site (N), at the perinecrotic bone (PB), and in the non-lesional-bone site (CB) were assessed.

Results: Higher sclerostin levels were observed in ORN (90, p = 0.04) and MRONJ (133, p < 0.01) vs. CG (45). ALP differed (p < 0.01) between MRONJ (60.2) and CG (79.3). All radiographic parameters revealed significant differences among the 3 sites (p < 0.05). A multivariate analysis showed an association of sclerostin with Mgv at N (p = 0.002) and Lac (p < 0.004) at CB, and an association of ALP with Mgv at N (p < 0.01), SDgv at PB (p < 0.01), and with sclerostin (p < 0.01).

Conclusions: Serum sclerostin levels were higher in patients with osteonecrosis. ALP levels were lower in MRONJ patients than in CG. Both proteins were associated with each other and with radiographic findings.