Medication-related osteonecrosis of the jaw: An update

Bansal, Hitesh

doi:10.4103/njms.njms_236_20

Cited by 12 publications

(14 citation statements)

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“…Recent studies have indicated the utilization of innovative therapeutic approaches, including platelet-rich plasma, hyperbaric oxygen therapy, laser therapy, and parathyroid hormone administration [ 27 ]. Nevertheless, the effectiveness of these treatment modalities has not been definitively established [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Ibandronic Acid Induced Non-Exposed BRONJ Involving the Maxillary Sinus

Fotopoulos,

Zisis,

Lillis

et al. 2023

JOMR

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Background The aim of this case report is to present an interesting case of bisphosphonate-related osteonecrosis of the jaw, involving the maxilla and the maxillary sinus, as a result of per os administration of ibandronic acid. Methods A female patient, 62 years old, was referred to the Department of Dentoalveolar Surgery, Surgical Implantology and Radiology, School of Dentistry, Aristotle University of Thessaloniki, Greece, complaining about pain in the first quadrant. Her medical history revealed per os bisphosphonate administration for the past four years. Subsequently, the cone-beam computed tomography examination revealed a small sequestrum of bone, surrounded by radiolucency, in proximity with the sinus floor. The clinical examination didn’t reveal any pathological clinical signs. Results Based on the radiological examination, a surgical approach was implemented to remove the necrotic bone, irrigate the alveolar process and the sinus with saline, and finally achieve primary closure, after which, the patient healed uneventfully. The osteonecrosis was attributed to the bisphosphonate administration. Conclusions Bisphosphonate-related osteonecrosis of the jaw without obvious or with minor implication of gingival tissues is a diagnostic challenge indicating an early stage of this adverse reaction. Imaging is critical for the early detection of those cases. After careful choice of the case the proper surgical intervention could be effective to eliminate a future advancement of bone destruction. The prevention of osteonecrosis of the jaw can be achieved through the provision of adequate education to dental medicine practitioners, medical doctors, and patients.

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Section: Discussionmentioning

confidence: 99%

A Case Report of Ibandronic Acid Induced Non-Exposed BRONJ Involving the Maxillary Sinus

Fotopoulos,

Zisis,

Lillis

et al. 2023

JOMR

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“…These signs and symptoms may occur spontaneously or following dentoalveolar surgery. Intraoral or extraoral fistulae may develop when the necrotic maxilla and mandible become secondarily infected [1][2][3][4][5]21].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Some cases may present with oral pimples or gum boils, which are sinus tracks without exposed bone. In patients with maxillary bone involvement, chronic maxillary sinusitis secondary to osteonecrosis with or without an oroantral fistula may be the clinical presentation [1][2][3][4][5]21].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Osteonecrosis of the jaw (ONJ), currently known as medication-related osteonecrosis of the jaw (MRONJ), has been described as an uncommon complication of antiresorptive therapy (ART) for cancer and some benign conditions, as well as with drugs inhibiting angiogenesis [1,2]. Antiresorptive agents like bisphosphonates (BP) are inorganic pyrophosphates that decrease bone turnover and are used to reduce or delay skeleton-related events (SRE) like fractures in patients with metastatic lytic lesions, hypercalcemia of malignancy, multiple myeloma (MM), Paget's disease, and osteoporosis [1,2]. There is a higher risk for MRONJ in cancer patients receiving frequent and higher doses of osteoclast inhibitors.…”

Section: Introductionmentioning

confidence: 99%

“…The phossy jaw was mainly reported in match makers who were exposed to white phosphorus [5]. The American Association of Oral and Maxillofacial Surgeons (AAOMS) identified jaw necrosis as the basis of complications from other drugs, including receptor activator of nuclear factor kappa beta ligand (RANKL) inhibitor denosumab and antiangiogenic agents, and coined the term medication-related osteonecrosis of the jaw [1][2][3]. The Multinational Association of Supportive Care in Cancer (MASCC), the International Society of Oral Oncology (ISOO), and the American Society of Clinical Oncology (ASCO) also endorsed this terminology (MRONJ) in a joint guideline [6].…”

Section: Introductionmentioning

confidence: 99%

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A Narrative Review of Osteonecrosis of the Jaw: What a Clinician Should Know

Sharma,

Shankar,

Ravi Kiran

et al. 2023

Cureus

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Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon complication of antiresorptive therapy (ART) in patients receiving higher and more frequent doses of osteoclast inhibitors. The jaws are the most common site, as they have high bone turnover. The oral structures are exposed to various types of stresses, like mastication and dental diseases, which lead to microtrauma and increased bone remodeling. The hallmark feature of MRONJ is the area of exposed, necrotic, nonhealing, asymptomatic bone for more than eight weeks. Objective signs are pain in the jaw and oral cavity, loose teeth, gingival swelling, ulceration, soft tissue infection, and paresthesia in the trigeminal nerve branches' territory. Clinically, the MRONJ has been defined in four stages, from stage 0 to stage 3. Close coordination between the dentist and oncologist is critical for optimal treatment. Conservative management should be preferred over surgical management. There is significant underreporting and misdiagnosis of MRONJ cases in regular clinical practice. There needs to be more awareness among treating physicians about this sporadic complication of bisphosphonate therapy. This narrative review has given a detailed insight into the subject, starting with etiology, pathogenesis, incidence, clinical presentation, workup, staging, and various management strategies. The review article focuses mainly on practical aspects of MRONJ, which every clinician dealing with the disease must know. With a better awareness of this potential complication, healthcare practitioners dealing with at-risk patients can better diagnose, prevent, address, and provide necessary care.

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Risk comparison of osteonecrosis of the jaw in osteoporotic patients treated with bisphosphonates vs. denosumab: a multi-institutional retrospective cohort study in Taiwan

2023

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Summary In this multi-institutional retrospective cohort study, we compared the long-term risk of osteonecrosis of the jaw following the use of denosumab vs. bisphosphonates in osteoporotic patients. After 2-year use, the likelihood of osteonecrosis of the jaw is lower with denosumab compared to bisphosphonates, and the difference increases with time. Purpose To compare the long-term risk of osteonecrosis of the jaw (ONJ) between osteoporotic patients treated with bisphosphonates (BPs) and denosumab. Methods This multi-institutional retrospective cohort study included patients aged > 40 years with osteoporosis between January 2010 and December 2018. Patients who met the eligibility criteria were divided into BPs and denosumab groups by propensity score matching (PSM). The risk of ONJ of denosumab vs. BPs was estimated using a Cox proportional hazards model and was described by the cumulative incidence rate using the Kaplan–Meier method. Results A total of 84,102 patients with osteoporosis were enrolled, among whom, 8962 were eligible for inclusion based on their first-line drug use (denosumab, n = 3,823; BPs, n = 5,139). Following PCM matching (1:1), the BPs and denosumab groups included 3665 patients each. The incidence density of ONJ in the denosumab and BPs matching groups was 1.47 vs. 2.49 events (per 1000 person-years), respectively. The hazard ratio of ONJ in the denosumab vs. BPs group was estimated as 0.581 (95% confidence interval: 0.33–1.04, p = 0.07). The cumulative incidence rates of ONJ in both groups were similar for the first and second years of drug use ( p = 0.062), but significantly different from the third year onwards ( p = 0.022). The severity of ONJ was not significantly different between the two groups. Conclusion In osteoporotic patients, after 2 years of use, the likelihood of ONJ being induced by denosumab is lower than that of BPs, and the difference increases with time. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-023-06818-3.

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Medication-related osteonecrosis of the jaw: An update

Cited by 12 publications

References 68 publications

A Case Report of Ibandronic Acid Induced Non-Exposed BRONJ Involving the Maxillary Sinus

A Case Report of Ibandronic Acid Induced Non-Exposed BRONJ Involving the Maxillary Sinus

A Narrative Review of Osteonecrosis of the Jaw: What a Clinician Should Know

Risk comparison of osteonecrosis of the jaw in osteoporotic patients treated with bisphosphonates vs. denosumab: a multi-institutional retrospective cohort study in Taiwan

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