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. 2025 Aug 11;29(1):140.
doi: 10.1007/s10006-025-01439-y.

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

Riéli Elis Schulz  1 , Sandro Wopereis  2 , Juliana Lucena Schussel  3 , Laurindo Moacir Sassi  3 , Aira Maria Bonfim Santos  2 , Liliane Janete Grando  2 , Rogério Oliveira Gondak  4 , Gustavo Davi Rabelo  5   6   7
Affiliations

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

Riéli Elis Schulz et al. Oral Maxillofac Surg. .

Abstract

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.

Keywords: Fractals; Human; Oral medicine; Osteonecrosis; Panoramic radiography; SOST protein.

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Conflict of interest statement

Declarations. Ethical approval: Ethical approval was waived by the local Ethics Committee of the Federal University of Santa Catarina (Register number CAAE: 54374221.3.0000.0121) and Erasto Gaertner Hospital (Register number CAAE: 54374221.3.3001.0098), in view of the prospective nature of the study and all the procedures performed were part of the routine care of the patients, and in accordance with the Declaration of Helsinki. Competing interests: The authors declare no competing interests. Generative AI and AI-assisted technologies in the writing process: During the preparation of this work the authors used ChatGPT 3.5 ( https://chatgpt.com/ ) in order to review the grammatic and the textual content. After using this tool/service, the authors reviewed and edited the content as needed and took full responsibility for the content of the publication.

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