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PATIENTS AT RISK OF OSTEONECROSIS OF THE JAW (ONJ) INCLUDE MOSTLY CANCER AND MYELOMA PATIENTS RECEIVING ANTIRESORPTIVE TREATMENTS (BISPHOSPHONATES AND DENOSUMAB) WITH/WITHOUT BIOLOGICAL AGENTS,  BUT ALSO PATIENTS WITH OSTEOPOROSIS AND RHEUMATOLOGIC DISORDERS. ONJ CASES WERE FIRSTLY DIAGNOSED IN OUR HOSPITAL ON 2005. SINCE 2006, A ONJ MULTIDISCIPLINARY TEAM WAS ESTABLISHED (INCLUDING MAXILLOFACIAL SURGEONS / DENTISTS, ONCOLOGISTS, HEMATOLOGISTS, NURSES, RADIOLOGISTS, NUCLEAR MEDICINE AND OTHER MEDICINE  SPECIALISTS, DATA MANAGERS). PREVENTIVE (RISK REDUCTION) MEASURES BEFORE ANTIRESORPTIVE TREATMENT (DENTAL VISIT, DENTAL PANORAMIC RX, EVENTUAL TEETH EXTRACTIONS, DENTAL AND DENTURE CARE) HAVE BEEN PLANNED, ACCORDING TO EARLY RECOMMENDATIONS AND THEIR MODIFICATIONS. FURTHERMORE IN THE OSTEONECROSIS PREVENTION AND SCREENING OFFICE OTHER PATIENTS RECEIVED CARE IF : A)  ONJ WAS SUSPECTED AFTER TREATMENT FOR CANCER AND MYELOMA IN  NEIGHBORING HOSPITALS, OR B) ONJ WAS SUSPECTED AMONG OSTEOPOROSIS PATIENTS IN THE TERRITORY BY PRIVATE PRACTICE DENTISTS. MORE THAN 900 PATIENTS WERE VISITED AND REGISTERED IN 2006-2020 YEARS. CASES OF SUSPECTED ONJ WERE 127 (45 MALE, 82 FEMALE). TWENTY-FOUR CASES WERE EXCLUDED BY ANALYSIS DUE TO UNCONFIRMED DIAGNOSIS OR INSUFFICIENT DATA.  CHARACTERISTICS OF 103 CASES OF ONJ CONFIRMED ACCORDING TO ITALIAN (SIPMO-SICMF) DEFINITION AND RECOMMENDATIONS WERE REVIEWED. DISEASE: 40 BREAST CANCER; 16 PROSTATE CANCER; 11 MYELOMA; 7 RENAL CELL CANCER; 4 LUNG CANCER; 7 OTHER CANCERS; 18 OSTEOPOROSIS AND OTHER NON MALIGNANT DISORDERS. DISTRIBUTION OF DRUGS ASSOCIATED TO ONJ (ZOLEDRONIC ACID, DENOSUMAB, PAMIDRONATE, ALENDRONATE, RISEDRONATE, IBANDRONATE, CLODRONATE, BEVACIZUMAB, SUNITINIB) CHANGED ALONG YEARS.

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Charts of all myeloma patients observed at the Hematology Unit of Alessandria Hospital (Italy) in years 2005-2020 have been reviewed.  Patients received bisphosphonates according to international guidelines, that recommended shorter and tailored duration of antiresorptive treatment (instead of indefinitively prolonged administration, as advised by older guidelines) after 2006-2007. Out of 210 patients receiving pamidronate or zoledronic acid (or sequences of bisphosphonates) and evaluated for oral health, 7 cases of Osteonecrosis of the Jaw (ONJ) were registered (7/210, 3.3%).  However, 5 cases were detected among 41 cases starting antiresorptive treatment before 2006 without preventive visit, and only 2 cases were found among 169 cases receiving dental visit before treatment beginning (2/169, 1.2%). Our data seem confirm efficacy of measures directed to reduce the risk of ONJ in myeloma patients treated with less intensive schedules of bisphosphonates, according to latest recommendations..