A multicenter case registry study on medication-related osteonecrosis of the jaw in patients with advanced cancer

Abstract

PurposeThis observational case registry study was designed to describe the natural history of cancer patients with medication-related osteonecrosis of the jaw (ONJ) and evaluate the ONJ resolution rate.MethodsAdults with a diagnosis of cancer and with a new diagnosis of ONJ were enrolled and evaluated by a dental specialist at baseline and every 3 months for 2 years and then every 6 months for 3 years until death, consent withdrawal, or loss to follow-up. The primary endpoint was the rate and time course of ONJ resolution. Secondary endpoints included frequency of incident ONJ risk factors, ONJ treatment patterns, and treatment patterns of antiresorptive agents for subsequent ONJ.ResultsOverall, 327 patients were enrolled; 207 (63%) were continuing on study at data cutoff. Up to 69% of evaluable patients with ONJ had resolution or improvement during the study. ONJ resolution (AAOMS ONJ staging criteria) was observed in 114 patients (35%); median (interquartile range) time from ONJ onset to resolution was 7.3 (4.5–11.4) months. Most patients (97%) had received antiresorptive medication before ONJ development, 9 patients (3%) had not; 68% had received zoledronic acid, 38% had received denosumab, and 10% had received pamidronate (56% had received bisphosphonates only, 18% had received denosumab only, and 21% had exposure to both).ConclusionsThese results are consistent with those observed in clinical trials evaluating skeletal-related events in patients with advanced malignancy involving bone. Longer follow-up will provide further information on ONJ recurrence and resolution rates between medically and surgically managed patients.

Cloud-Based Multicenter Data Collection and Epidemiologic Analysis of Bisphosphonate-Related Osteonecrosis of the Jaws in a Central European Population

“…At the time of the diagnosis, the majority of the patients (53.3%) were categorized as stage 2; 20.0% and 26.7% were classified as stage 1 and stage 3, respectively. These findings are similar to those of Schiodt et al (stage 1: 26%; stage 2: 58%; stage 3: 10%; unknown: 3%; resolved: 2%) [39]. Although much more women than men are affected by BRONJ, their number in stage 3 is nearly the same (26 and 22, respectively).…”

“…Recently, some single-institution studies with a large number of patients have been published in this field [29][30][31][32]. The aim of our study was to create a multicenter data collection system that would gather demographic, clinical, and pharmacological data of a large number of patients suffering from BRONJ [33][34][35][36][37][38][39][40][41].…”

Preventing, identifying, and managing medication-related osteonecrosis of the jaw: a practical guide for nurses and other allied healthcare professionals

“…Surgical approaches to treatment include jaw resection, invasive sequestrectomy, and debridement [ 48 ]. Surgery may stop disease progression and lead to complete mucosal healing, with success rates of over 90% reported with certain procedures [ 45 , 47 ], but the criteria for selecting a patient for surgery are not always agreed upon and require further study.…”

Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw

“…When a suspected MRONJ patient consults a dentist or oncologist, the patient should be referred to a dental specialist for additional treatment management. 71 The dental specialist should evaluate the clinical stage, the severity of the disease and symptoms, functional impact and overall prognosis based on clinical manifestations following an 8-week follow-up plan. In accordance with the staging of MRONJ, the dental specialist should design a treatment plan for its management and report that plan to the oncologist.…”