Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies

Abstract

This retrospective cohort study aims to describe characteristics of patients with MRONJ, to identify factors associated with MRONJ development, and to examine variables associated with favourable outcome. Totally 32 patients were followed and observed: 21 females and 11 males, in the age range 35-84 in the period from 2009 to 2018. Clinical, radiological examination (Orthopantomograph and CBCT) and biopsy were performed in order to achieve diagnosis. Demographic and clinical variables were taken into consideration: sex, age, primary disease, medication type, mode of delivery, anatomic location, drug treatment duration, timing of tooth extraction, chemotherapy, presence of bone metastasis, aetiology of MRONJ, disease stage, and treatment modality. MRONJ developed under osteoporosis and malignant disease in 11 and 21 patients, respectively. MRONJ development was triggered by tooth extraction or trauma in 30 out of 32 cases, whereas the two patients developed MRONJ spontaneously. Stages I, II, and III were confirmed in 5 (16%), 18 (58%), and 9 (28%) patients, respectively. Mandible was affected in 23 (72%) patients. MRONJ was treated in our department by conservative and surgical modality. In this study we found that 65% of all patients were classified in the cured/improvement group and 35% in the stable/progression group. The female gender, osteoporosis as primary disease, oral regime intake, shorter period on BPs, earlier stage of disease, and specific anatomic localisation (frontal and premolar maxilla) were factors associated with better response to therapy and favourable clinical outcome. Comprehensive treatment protocol and further randomized studies are necessary for further improvements.

Factors Influencing Severity of Medication-Related Osteonecrosis of the Jaw: A Retrospective Study

“…27,28 Early surgical treatment may prevent progression of the lesions, reduce risk of postoperative recurrence, and improve prognosis. [28][29][30] In this study, we found preoperative MRONJ duration $12 months to be associated with advanced MRONJ stage; this finding supports the view of early surgical treatment for MRONJ.…”

Alterations in macrophage polarization in the craniofacial and extracranial skeleton after zoledronate application and surgical interventions – an in vivo experiment

“…The importance of tooth extraction in enhancing a pro-inflammatory environment in the tooth extraction socket was verified by comparing the operated- and non-operated side of the jaw bone in Zol-treated rats. It is well accepted that tooth extraction is a major risk factor for the development of MRONJ ( 54 ).…”

Medication‐related osteonecrosis of the jaw: A disease of significant importance for older patients

“…About 65% of these cases were cured by conservative and surgical therapies while the remaining cases did not heal. The authors have determined that the context of osteoporosis, orally administered bisphosphonates over a shorter duration of time as well as the localization of necrosis around the frontal and premolar maxilla, represent factors associated with a better outcome 53 …”