Incidence and risk factors for medication‐related osteonecrosis after tooth extraction in cancer patients—A systematic review

Abstract

Objectives: Antiresorptive medication has been reported to be associated with medication-related osteonecrosis of the jaw (MRONJ). This systematic review aims at investigating the incidence of and risk factors for MRONJ after tooth extractions in cancer patients treated with high-dose bisphosphonate and denosumab (BP and DS).Material and Methods: The protocol followed the PRISMA statement list and was registered in PROSPERO. Searches were performed for literature published up to April 2021 in the electronic databases PubMed, Embase, Web of Science, and CINAHL and then supplemented by manual research. Results:The search process resulted in 771 identified articles, of which seven studies fitted the population, intervention, comparison, and outcome framework. All were observational studies and four had control groups. A total of 550 patients treated with BP and DS were identified of whom 271 had received tooth extractions after medication onset. Due to significant heterogenicity in the collected data, only a qualitative analysis was performed. The MRONJ incidence after tooth extractions varied between 11% and 50% at the patient level. MRONJ occurred up to 3 years after the tooth extraction. Teeth affected by inflammation before the extraction and additional osteotomy during the surgical procedure were identified as risk factors.Conclusions: Reliable methods of diagnosing MRONJ and adequate follow-up periods are important factors in obtaining the actual incidence of MRONJ after tooth extractions in patients treated with high-dose BP and DS.

A real‐world study on the prevalence and risk factors of medication related osteonecrosis of the jaw in cancer patients with bone metastases treated with Denosumab

“…Similarly to previous reports, 15,27,32,33 at multivariate analysis (Table 3), we found MRONJ to be significantly associated with dental treatments (HR = 3.67; 95% CI: 1.95, −6.88; p = 0.0001), especially dental extraction (HR = 23.40; 95% CI: 12.98–47.18; p < 0.0001) which was found to be the most common event preceding MRONJ onset. In fact, 28 (50%) out of the 56 MRONJ patients had previously had at least one extraction.…”

“…5,30 A recent systematic review and meta-analysis of randomized controlled trials has reported an incidence of MRONJ in cancer patients under treatment with Dmab which ranged from 0.5% to 2.1% after 1 year, 1.1% to 3.0% after 2 years, and 1.3% to 3.2% after 3 years of exposure. 31 Similarly to previous reports, 15,27,32,33 at multivariate analysis (Table 3), we found MRONJ to be significantly associated with dental treatments (HR = 3.67; 95% CI: 1.95, −6.88; p = 0.0001), especially dental extraction (HR = 23.40; 95% CI: 12.98-47.18; p < 0.0001) which was found to be the most common event preceding MRONJ onset. In fact, 28 (50%) out of the 56 MRONJ patients had previously had at least one extraction.…”

Unveiling Medication-Related Osteonecrosis of the Jaw: A Rapid Review of Etiology, Drug Holidays, and Treatment Strategies

“…Complementing these findings, another review specifically focused on cancer patients treated with high-dose BP and DS [15]. This review reported a varying MRONJ incidence rate of 11% to 50% after tooth extractions, emphasizing the significant heterogeneity in the collected data [15].…”

“…Tooth extraction in patients undergoing antiresorptive medication therapy, such as BPs and DS, has been closely scrutinized due to the associated risk of MRONJ. Recent systematic reviews shed light on the incidence rates and risk factors tied to MRONJ following tooth extractions, underscoring the complex interplay between medication use, dental procedures, and patient characteristics [14,15].…”

Medication-Related Osteonecrosis of the Jaw: A Cross-Sectional Survey among Urologists in Switzerland, Germany, and Austria

“…In addition, the use of corticosteroids and concomitant systemic diseases, such as diabetes mellitus, hypertension, renal failure, and immunosuppression, enhance the likelihood of developing MRONJ [ 22 , 23 , 24 ]. Furthermore, invasive dental measures (e.g., tooth extraction), preexisting periodontal inflammation, and prosthesis-related oral mucosal lesions represent significant risk factors for MRONJ, as has also been demonstrated in preclinical research using primarily rodent models [ 25 , 26 , 27 , 28 ].…”