Comparison of nonexposed and exposed bisphosphonate-induced osteonecrosis of the jaws: a retrospective analysis from the Copenhagen cohort and a proposal for an updated classification system

Osteonecrosis of the Jaw Developed in Mice

“…However, although the severe bone exposure variant was observed from the early BP treatment stage, the nonexposure variant was not reported until patients received repeated BP injections (35). ONJ patients who had received multiple injections of BP have been shown to develop deficiency of circulating ␥␦ T cells (17).…”

Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology

“…[23][24][25][26][27][28][29][30] Finally, in 2014, an AAOMS special committee released a third position paper [31] changing the term from BRONJ to medicationrelated ONJ (MRONJ) in order to include cases linked to the treatment with denosumab and those arising after antiangiogenic drugs and targeted therapies; the document enlarged the definition of disease to include cases with 'bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region that has persisted for longer than 8 weeks' and confirmed the existence of a 'stage 0 category' for patients with signs and symptoms without bone exposure. On the other hand, an international task force recently confirms the ASBMR 2007 definition without the AAOMS 2009 and 2014 amends.…”

“…[103] Obviously, prospective collection and registration of data could be of even higher value, even if not uniformly applicable. [30] Furthermore, any data are to be interpreted with caution due to difficult adjudication of the adverse drug reaction to one drug or to another in cancer patients often receiving a large number of drugs simultaneously or in sequence.…”

“…On the other hand, the AAOMS definition of ONJ has been recently found to be 'unfit for purpose' in the spontaneous reporting database: by authors its use should be avoided, leading to the exclusion of over 70% of cases from the database. [106] An effective improvement in the ONJ staging was demonstrated by CT. [28,30] Finally, it appears particularly challenging for the determination of early imaging (CT) signs of bone alteration, already described in BP-related ONJ [24,36]; moreover, this kind of imaging could be potentially valuable not only in order to facilitate recognition of ONJ without bone exposure but also to make easier the differential diagnosis between ONJ and drug-related long-lasting stomatitis, a possible problem after some drug treatment (e.g. everolimus).…”

K. Skoglund & O. Hjortdal svarer:

“…Dette er ikke alltid riktig, og han synes da å vaere ukjent med nyere litteratur som viser at såkalte lukkede tilfeller, uten slimhinnelesjon, kan opptre i opptil 29 -45 % av tilfellene (4,5). I en nyere studie gjennomgår forfatterne et materiale på 102 pasienter og viser at 14 % av tilfellene er uten slimhinnelesjoner (6). De foreslår en klassifikasjon av kjeveosteonekrose i såkalt erosive og nonerosive former.…”