CTX Test

Information on the serum CTX Test

Patients that have osteoporosis / osteopenia will take bisphosphonates (bone-sparing drugs) to prevent hip and other bone fractures.  These medications last many, many years in the body and can have detrimental effects with certain dental treatment (implants, extractions, soft tissue grafting).  There is a test to determine if patients taking bisphosphonates are at risk for osteonecrosis (dead bone) following dental treatment. This test is called the Collagen Type-1 C-Telopeptide (CTX) test.  The serum CTX (C-Terminal Cross-Linking Telopeptide) measures the rate of bone turnover and can be affected with patients taking bone-sparing drugs for osteoporosis/osteopenia.

This information is of great value in assessing the risk of bisphosphonate induced osteonecrosis of the jaw (ONJ) according to Marx1 indicates the following: Laboratory Risk Assessment for Patients taking oral bisphosphonates


CTX Value Risk for ONJ
300 to 600 pg/ml (normal) none
150 to 299 pg/ml none to minimal
101 to 149 pg/ml moderate
Less than 100 pg/ml high

DX Code- V5869
1 Marx RE. Oral and Intravenous Bisphosphonate Induced Osteonecrosis of Jaws. History, Etiology, Prevention and Treatment. Quintessence Publishing Co. Inc. Hanover Park, IL 2007. Pg. 84.

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