Denosumab and osteonecrosis of the jaw. A systematic analysis of events reported in clinical trials

Boquete-Castro, Ana; Gómez‐Moreno, Gerardo; Calvo-Guirado, José Luís; Aguilar‐Salvatierra, Antonio; Delgado-Ruíz, Rafael Arcesio

doi:10.1111/clr.12556

Cited by 137 publications

(95 citation statements)

References 52 publications

(81 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There is not sufficient information accumulated yet on imaging and histopathological characteristics of DRONJ that allows us to compare with those of BRONJ [16 Incidence of DRONJ in cancer patients is reported to be less than 2% and equivalent to that of BRONJ [6,11]. In contrast, incidence of DRONJ in osteoporosis patients is unknown.…”

Section: ② Dronjmentioning

confidence: 99%

Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw

et al. 2016

View full text Add to dashboard Cite

Section: ② Dronjmentioning

confidence: 99%

Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw

et al. 2016

View full text Add to dashboard Cite

“…veolar procedures, but now it is accepted that similar lesions can occur also in patients receiving other types of ARDs(Aljohani et al, 2017;Boquete-Castro, Gómez-Moreno, Calvo-Guirado, Aguilar- Salvatierra, & Delgado-Ruiz, 2016). The pathogenesis of the condition is not completely understood and seems to be multifactorial, but one mechanism among others is that bone is more vulnerable to infection due to decreased remodeling.…”

mentioning

confidence: 99%

The effect of antiresorptive drugs on implant therapy: Systematic review and meta‐analysis

Stavropoulos

Bertl

Pietschmann

et al. 2018

Clinical Oral Implants Res

100

View full text Add to dashboard Cite

Objectives: A considerable portion of the adult population has received and/or is receiving treatment with antiresorptive drugs (ARDs). It is thus relevant to assess possible side effects of ARD intake in connection to various aspects of implant therapy. The aim of this study was to answer the focused question "In patients with systemic intake of ARDs, what is the outcome and complication rate of implant therapy including associated bone grafting procedures comparing to patients without systemic intake of ARDs?" Materials and Methods:Original studies fulfilled predefined inclusion criteria (e.g., case series, cohort studies, case-control studies, and controlled and/or randomized controlled clinical trials; retro-or prospective design; and ≥10 patients with systemic intake of ARDs). Various patient-, medication-, and intervention-related parameters [i.e., implant loss, grafting procedure complication/failure, peri-implant marginal bone levels/loss, medication-related osteonecrosis of the jaws (MRONJ), and periimplantitis] were extracted, and meta-analyses and quality assessment were performed. Results:Twenty-four studies with bisphosphonate (BP) intake (mainly low dose for osteoporosis treatment) and seven studies on hormone replacement therapy (HRT), including ≥10 patients, and controls not taking the medication were identified.Furthermore, seven studies on MRONJ associated with implants were included.Meta-analyses based on four studies reporting on patient level and eight studies reporting on implant level showed no significant differences in terms of implant loss between patients on BPs (mainly low dose for osteoporosis treatment) and controls.Furthermore, low-dose BP intake did not compromise peri-implant marginal bone levels. Based on two studies, no negative effect of HRT was observed on the implant level, while HRT appeared to exert a marginally significant negative effect regarding implant survival on the patient level and regarding peri-implant marginal bone levels.Based on six studies reporting single-patient data, MRONJ in patients on BP for osteoporosis appeared in 70% of the cases >36 months after start of drug intake, while in patients with cancer, MRONJ appeared in 64% of the cases ≤36 months after first BP intake.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. | 55STAVROPOULOS eT AL. | 57 STAVROPOULOS eT AL.Random-effects meta-analyses, separately for each ARD type, were implemented to calculate from the included cohort and casecontrol studies pooled estimates at the patient and/or implant level.All statistical analyses were performed using Stata (StataCorp LLC, USA).

show abstract

“…Nevertheless, in initial stages ONJ may remain asymptomatic. Clinical presentation of ONJ is quite similar for both bisphosphonates and denosumab, involving the same affected areas of mandible and the same predisposing factors for ONJ (Boquete-Castro et al, 2016). Radiographs, computed tomography or magnetic resonance imaging may assist in the diagnosis of ONJ and offer additional data regarding the presence or extent of osteomyelitis and/or necrotic bone (sequestrum) formation (Bedogni et al, 2008).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Antiresorptive treatment-associated ONJ

Eleutherakis‐Papaiakovou

Bamias

2017

Eur J Cancer Care

View full text Add to dashboard Cite

Osteonecrosis of the jaw (ONJ) is a severe complication of therapy with antiresorptive agents (e.g. bisphosphonates and denosumab), which are used to manage bone metastases from cancer, to reduce the incidence of skeletal-related events. Available data indicate that 0-27, 5% of patients exposed to antiresorptive agents may develop ONJ, depending on the number of infusions and the duration of therapy. Besides antiresorptive therapy, a number of risk factors for osteonecrosis have been identified. Oral surgical procedures, tooth extractions and infection to the jawbones are considered the main risk factors for developing ONJ, when receiving antiresorptive therapy. However, a growing number of patients develop ONJ without apparent risk factors, raising concern for other predisposing factors. Jaw bone necrosis may be irreversible, resulting in a chronic disease with negative impact on the quality of patients' lives. The role of risk reduction strategies like meticulous dental screening and optimal oral hygiene is fundamental for preventing development of ONJ. ONJ is usually treated conservatively to relieve the symptoms and manage jaw bone necrosis. In certain cases, surgical intervention is required. Future research should emphasize individual predisposition to ONJ, more effective preventive measures and more efficient therapeutic procedures.

show abstract

Denosumab and osteonecrosis of the jaw. A systematic analysis of events reported in clinical trials

Abstract: Denosumab combined with risk factors such as dental extraction, poor oral hygiene, use of removable apparatus, and chemotherapy may favor the development of ONJ.

Cited by 137 publications

References 52 publications

Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw

Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw

The effect of antiresorptive drugs on implant therapy: Systematic review and meta‐analysis

Antiresorptive treatment-associated ONJ

Contact Info

Product

Resources

About