A Retrospective Study Evaluating Frequency and Risk Factors of Osteonecrosis of the Jaw in 576 Cancer Patients Receiving Intravenous Bisphosphonates

Thumbigere‐Math, Vivek; Tu, Lam; Huckabay, Sabrina; Dudek, Arkadiusz Z.; Lunos, Scott; Basi, David L.; Hughes, Pamela J.; Leach, Joseph W.; Swenson, Karen K.; Gopalakrishnan, Rajaram

doi:10.1097/coc.0b013e3182155fcb

Cited by 94 publications

(115 citation statements)

References 37 publications

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“…No significant association was detected between the diagnosed malignancy and the development of BRONJ (P=0.09). In certain previous studies, no association was found between the diagnosis and BRONJ, while in other studies it was identified that BRONJ was encountered at a higher rate in patients with MM in comparison to the patients with breast cancer (15,(21)(22)(23)(24)(25).…”

Section: Discussionmentioning

confidence: 81%

“…The present study determined that the frequency of BRONJ reached 3.6% in patients diagnosed with a malignancy that was treated using intravenous administration of ZA. In the literature, the rate of ONJ development in patients with malignancies treated using intravenous BP administration has been reported as 1.2, 3.1 and 5% in different studies (18,(21)(22)(23)(24)(25). It was hypothesized that other factors such as the usage period of the medication, patient diagnoses, presence of chronic disease and presence of other medication usage may have had an effect on the difference in these rates (23).…”

Section: Discussionmentioning

confidence: 99%

“…It was hypothesized that other factors such as the usage period of the medication, patient diagnoses, presence of chronic disease and presence of other medication usage may have had an effect on the difference in these rates (23). Also, the differences in ethnicity and particularly in dental hygiene habits affected the risk of BRONJ (15,(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, the rate of ONJ development in patients with malignancies treated using intravenous BP administration has been reported as 1.2, 3.1 and 5% in different studies (18,(21)(22)(23)(24)(25). It was hypothesized that other factors such as the usage period of the medication, patient diagnoses, presence of chronic disease and presence of other medication usage may have had an effect on the difference in these rates (23). Also, the differences in ethnicity and particularly in dental hygiene habits affected the risk of BRONJ (15,(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

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Effect of the cumulative dose of zoledronic acid on the pathogenesis of osteonecrosis of the jaws

et al. 2015

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Abstract. Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe bone disease for which the pathogenetic mechanisms and risk factors are not fully understood. The present study evaluated the data of 652 patients with bone metastasis that had undergone treatment with biphosphonates. Subsequently, 24 patients with BRONJ and 20 control patients without BRONJ that were treated with zoledronic acid were enrolled. It was found that BRONJ occurred in 3.6% of patients. The mean age and the administration of dental treatment were found to be significantly associated with BRONJ development (P=0.049 and P=0.013, respectively). The cumulative dose median in the BRONJ group was found to be significantly higher compared with the cumulative dose average in the control group (P=0.037). In addition, at the time of BRONJ development, improvement in the disease was determined to be better in the BRONJ group than in the control group (P=0.031). The present study determined that age, the existence of dental extraction and the cumulative dose of zoledronate were all important risk factors in BRONJ development.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of the cumulative dose of zoledronic acid on the pathogenesis of osteonecrosis of the jaws

et al. 2015

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“…With a such low incidence of ONJ, the benefit of the high-dose antiresorptive therapy largely outweighs the risk of ONJ by a factor of 17 (3). The incidence of ONJ in cancer patients appears to be related to many factors such as the dose used, the duration of the treatment, the specific kind of malignancy (with a higher risk in patients with breast or prostate cancer or with multiple myeloma) (8). Furthermore, the use of concurrent drugs potentially interfering with bone health should be considered (i.e.…”

Section: Reviewmentioning

confidence: 99%

Drug-induced osteonecrosis of the jaw: the state of the art

et al. 2017

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Osteonecrosis of the jaw (ONJ) is a rare adverse event of antiresorptive drugs such as bisphosphonates (BP) and denosumab (DMAb). The diagnosis of ONJ is considered in cases where exposed bone in the maxillofacial region does not heal within 8 weeks in a patient previously treated with an antiresorptive agent. In patients with osteoporosis, ONJ is reported as a very rare adverse event while in oncologic patients with bone metastases or malignant hypercalcemia the incidence is significantly higher (up to the 1-10% of the patients). The pathophysiology of ONJ is still not completely understood but it is multi-factorial. ONJ is a condition associated with poor oral health, oral surgery, and use of antiresorptive agents. Prevention is of paramount importance especially in cancer patients, in whom the large majority of cases of ONJ (>90%) are reported, but it should also be considered in osteoporotic patients, especially during dental surgical procedure. Some simple prevention procedures are effective in reducing the risk of its appearance. When ONJ unfortunately occurs, the large majority of patients can be managed conservatively. In conclusion, ONJ is a rare condition associated with antiresorptive drugs. Both osteoporotic and oncologic patients should be well informed about its low absolute risk and regarding the fact that the benefits of antiresorptive therapy far outweigh this potential risk of ONJ.

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Bisphosphonates in multiple myeloma: an updated network meta-analysis

Mhaskar

Kumar

Miladinović

et al. 2017

Cochrane Database of Systematic Reviews

104

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A Retrospective Study Evaluating Frequency and Risk Factors of Osteonecrosis of the Jaw in 576 Cancer Patients Receiving Intravenous Bisphosphonates

Abstract: Increased cumulative doses and long-term BP treatment are the most important risk factors for BRONJ development. Type of BP, diabetes, hypothyroidism, smoking, and prior dental extractions may play a role in BRONJ development.

Cited by 94 publications

References 37 publications

Effect of the cumulative dose of zoledronic acid on the pathogenesis of osteonecrosis of the jaws

Effect of the cumulative dose of zoledronic acid on the pathogenesis of osteonecrosis of the jaws

Drug-induced osteonecrosis of the jaw: the state of the art

Bisphosphonates in multiple myeloma: an updated network meta-analysis

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