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SERUM-C TERMINAL CROSSLINKING TELOPEPTIDE (CTX) AS A PREDICTIVE BIOMARKER OF BISPHOSPHONATE-RELATED OSTEONECROSIS OF JAW (BRONJ): SYSTEMATIC REVIEW AND META-ANALYSISThe aim of this systematic review was to evaluate the validity of using preoperative serum C-terminal crosslinking telopeptide (CTX) levels as predictive factor of increased risk of developing medication-related osteonecrosis of the jaw (MRONJ) in patients on bisphosphonate (BP) therapy who undergo invasive dental procedures. A search was conducted through PubMed, MEDLINE, and Web of Science, following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was conducted on the risk ratio. The methodological index for nonrandomized studies (MINORS) and Quality Appraisal of Reliability Studies (QAREL) checklist were used to assess quality. Eighteen clinical trials, involving 2301 patients were included. Most patients received Alendronate or Risedronate for an average of 62.14 months. The average serum CTX level in BP-treated patients before surgery was 217.67 pg/ml. Meta-analysis demonstrated that the cutoff in CTX level (150 pg/ml) was not predictive of BRONJ risk. The sensitivity of CTX value <150 pg/ml was 34.26% and the specificity was 77.08%. The use of CTX to diagnose BRONJ risk following dental procedures in bisphosphonate-treated patients is not justified. Further studies are needed to develop other reliable biomarkers.