Bisphosphonate-related Osteonecrosis of Jaw (BRONJ) in Japanese Population: A Case Series of 13 Patients at Our Clinic

Abstract

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) affects quality of life and is an important problem for dentists. A Japanese position paper on BRONJ was published in 2010. The purpose of this study was to review clinical data on the treatment of BRONJ obtained at the Clinic of Oral and Maxillofacial Surgery, Tokyo Dental College, Chiba Hospital to further our understanding of this disease. A total of 13 patients (6 men and 7 women) were included. All the patients included in this study had received Bisphosphonate (BP) therapy and had BRONJ. Five of them (38.5%) had received oral BP therapy for osteoporosis, while the remaining 8 (61.5%) had received parenteral BP therapy for bone metastases from breast or prostate cancer. Osteoporosis patients were treated with risedronate or alendronate. Breast or prostate cancer patients were treated with zoledronate. Two patients with rheumatoid arthritis were treated with corticosteroid. Three patients had diabetes mellitus. Eleven patients were treated with antibiotics, while 5 underwent surgical treatment. Discontinuation of BP was recorded in 7 patients during dental treatment. Sequestration was observed in 6 patients during an 11-month follow-up. Eventually, healing and improvement of the oral mucosa were observed in 3 patients. The current standard treatment for BRONJ does not always provide good results. It is necessary to accumulate further clinical data to establish more effective treatment strategies for BRONJ.

Dental treatments, tooth extractions, and osteonecrosis of the jaw in Japanese patients with rheumatoid arthritis: results from the IORRA cohort study

“…Nomura reported two female Japanese patients with RA with ONJ, and both were over 70 years of age and were taking glucocorticoids [8]. Our study confirms these clinical characteristics [7,8] in our Japanese patients with RA. Our data suggest that Japanese rheumatologists and dentists may stop treatment with bisphosphonates before tooth extraction, and recognize patients with RA as being at high risk of ONJ if they are elderly woman who are glucocorticoid users and have comorbid diseases like diabetes.…”

“…Conte-Neto and colleagues reported that patients with RA who develop ONJ are usually women over the age of 60 years who are taking steroids and receiving long-term bisphosphonate therapy [7]. Nomura reported two female Japanese patients with RA with ONJ, and both were over 70 years of age and were taking glucocorticoids [8]. Our study confirms these clinical characteristics [7,8] in our Japanese patients with RA.…”

“…The prevalence (0.094 %) appears to be slightly higher in Japanese patients with RA, because the general prevalence of ONJ among patients who are prescribed oral bisphosphonates for the treatment of osteoporosis ranges from 0 to 0.04 %, with the majority below 0.001 % [25]. Nomura et al reported clinical characteristics of 13 Japanese patients with ONJ, among which two (15 %) had RA [8]. Several other case reports have discussed patients with RA complicated by ONJ, and suggested a possible association between RA and ONJ [26].…”

“…Osteonecrosis of the jaw (ONJ) is also an important issue for Japanese patients with RA, because bisphosphonates [6] are the first-line treatment for osteoporosis in this population, and bisphosphonate use appears to be associated with ONJ [7,8]. In 2011, the American Dental Association guidelines recognized the low risk of ONJ in patients with osteoporosis, and stated that discontinuation of oral bisphosphonates in these patients was not necessary [9].…”

“…However, a recent Japanese study suggested that discontinuation of osteoporosis medications may increase the risk of adverse events and dis-on medication-related ONJ (MRONJ) [11], and this topic has recently become a very important issue for both rheumatologists and dentists. Data in the literature are limited with regard to ONJ, bisphosphonate use, and MRONJ in Japanese patients with RA, although two Japanese patients with RA and ONJ who were treated with oral bisphosphonates have been reported [8].…”