Oral risk factors associated with medication-related osteonecrosis of the jaw in patients with cancer

Aoki, Kumiko; Shimotsuji, Hiroko; Nakashima, Chie; Kawakami, M.; Imai, Yumiko; Kirita, Tadaaki

doi:10.1007/s00774-020-01195-x

Cited by 19 publications

(25 citation statements)

References 31 publications

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“…Although exposure to zoledronic acid or denosumab is the primary risk factor for MRONJ in cancer patients, additional factors have been associated with MRONJ—but for most of these, their contribution in the co-occurrence of this reaction remains unclear. Predisposing oral factors to the development of MRONJ are receiving attention, and oral management is recommended for prevention, since it has proved effective in reducing the incidence of MRONJ [ 13 , 14 , 15 ]—but above all, MRONJ incidence may be influenced by the malignancy type/severity, as well as by the contemporaneous intake of anti-cancer drugs [ 16 , 17 , 18 , 19 , 20 ]. Therefore, a multidisciplinary evaluation of patients before the initiation of bone-modifying agents is recommended [ 21 , 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Cancer Patients at Risk for Medication-Related Osteonecrosis of the Jaw. A Case and Control Study Analyzing Predictors of MRONJ Onset

Marcianó

Ingrasciotta

Isgrò

et al. 2021

JCM

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The goal of this investigation was to identify potential risk factors to predict the onset of medication-related osteonecrosis of the jaw (MRONJ). Through the identification of the multiple variables positively associated to MRONJ, we aim to write a paradigm for integrated MRONJ risk assessment built on the combined analysis of systemic and local risk factors. The characteristics of a cohort of cancer patients treated with zoledronic acid and/or denosumab were investigated; beyond the set of proven risk factors a new potential one, the intake of new molecules for cancer therapy, was addressed. Registered data were included in univariate and multivariate logistic regression analysis in order to individuate significant independent predictors of MRONJ; a propensity score-matching method was performed adjusting by age and sex. Univariate logistic regression analysis showed a significant effect of the parameters number of doses of zoledronic acid and/or denosumab (OR = 1.03; 95% CI = 1.01–1.05; p = 0.008) and chemotherapy (OR = 0.35; 95% CI = 0.17–0.71; p = 0.008). The multiple logistic regression model showed that breast, multiple myeloma, and prostate cancer involved a significantly higher risk compared to lung cancer; a significant effect of the combined variables number of doses of zoledronic acid and/or denosumab (OR = 1.03; 95% CI = 1.01–1.06); p-value = 0.03) and exposure to novel molecule treatment (OR = 34.74; 95% CI = 1.39–868.11; p-value = 0.03) was observed. The results suggest that a risk assessment paradigm is needed for personalized prevention strategies in the light of patient-centered care.

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Section: Introductionmentioning

confidence: 99%

Cancer Patients at Risk for Medication-Related Osteonecrosis of the Jaw. A Case and Control Study Analyzing Predictors of MRONJ Onset

Marcianó

Ingrasciotta

Isgrò

et al. 2021

JCM

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“…Currently, increasing number of patients with MRONJ has been reported in recent years [8][9][10][11][12][13][14][15][16][17] . However, there is no general consensus for treatment of MRONJ, and it is still controversial.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of Medication-Related Osteonecrosis of the Jaw with Surgical Treatment

Kobayashi

Takahashi

Igarashi

et al. 2022

J. Hard Tissue Biology.

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In 2014, the American Association of Oral and Maxillofacial Surgery (AAOMS) recommended surgical treatment for medication-related osteonecrosis of the jaw (MRONJ) patients classified as Stage 3. In 2016, the Japanese position paper recommended surgical treatment classified as Stage 2. Some systematic review reported effectiveness of surgical treatment for MRONJ. However there is no concerted consciousness on the treatment methods of MRONJ patients in the present. This study aimed to retrospectively elucidate clinical outcomes of the surgical treatment of MRONJ patients under the same criteria. This study included 86 patients in 40 osteoporosis patients (5 men and 35 women, average age: 78.8 years) and 46 cancer patients (18 men and 28 women, average age: 67.7 years). The outcome was classified into two categories: Healing or No healing in each stage. Among 86 patients, MRONJ was found in 91 jaws, of which 69 jaws (75.8%) were surgically operated. Total healing rate of surgical treatment was 85.5%, and total healing rate of conservative treatment was 4.5%. It was suggested that surgical treatment for MRONJ had a high clinical response rate in all stages.

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“…However, tooth extraction, ill-fitting dentures, torus mandibularis, and infections at the periapical and periodontal areas are frequently mentioned as local risk factors and comorbid conditions in various studies. [ 61 , 66 , 67 ]…”

Section: Risk Factorsmentioning

confidence: 99%

“…Dental procedures accompanying alveolar bone exposure and damage, such as tooth extraction, dental implant installation, and removal, periodontal and periapical operations, may increase the occurrence of MRONJ and should be cautious in patients being treated with bone modifying agents. [ 60 , 61 , 66 – 68 ] Restorative dental treatment, endodontic treatment, and conservative periodontal therapies which do not directly involve alveolar bone tissue are reported to show minimal risk to MRONJ incidence.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Growing evidences are being suggested to include infections at the periapical and periodontal area as a local risk factor for MRONJ. [ 66 – 68 , 71 ] Those infections may trigger the occurrence of MRONJ without proper treatment or when treated improperly. Therefore, if the elimination of the dental infection is not possible, extraction should be considered with adequate postoperative care.…”

Section: Risk Factorsmentioning

confidence: 99%

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Medication Related Osteonecrosis of the Jaw: 2021 Position Statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons

et al. 2021

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Antiresorptives are the most widely prescribed drugs for the treatment of osteoporosis. They are also used in malignant bone metastases, multiple myeloma, and Paget's disease, and provide therapeutic efficacy on those diseases. However, it was reported that the occurrence of osteonecrosis of the jaw (ONJ) could be related to antiresorptive exposures, and there have been many cases regarding this issue. Therefore, a clearer definition and treatment guidelines were needed for this disease. The American Society for Bone and Mineral Research and the Amnerican Association of Oral and Maxillofacial Surgeons reported statements on bisphosphonate-related ONJ (BRONJ), and a revised version was recently presented. In the revised edition, the diagnosis BRONJ was changed to medication-related ONJ (MRONJ), which reflects consideration of the fact that ONJ also occurs for denosumab, a bone resorption inhibitor of the receptor activator of the nuclear factor-κB ligand antibody family, and bevacizumab, an anti-angiogenesis inhibitor. The Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons had collectively formed a task force for the preparation of an official statement on MRONJ based on a previous position paper in 2015. The task force reviewed current knowledge and coordinated dental and medical opinions to propose the guideline customized for the local Korean situation.

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Oral risk factors associated with medication-related osteonecrosis of the jaw in patients with cancer

Cited by 19 publications

References 31 publications

Cancer Patients at Risk for Medication-Related Osteonecrosis of the Jaw. A Case and Control Study Analyzing Predictors of MRONJ Onset

Cancer Patients at Risk for Medication-Related Osteonecrosis of the Jaw. A Case and Control Study Analyzing Predictors of MRONJ Onset

Prognosis of Medication-Related Osteonecrosis of the Jaw with Surgical Treatment

Medication Related Osteonecrosis of the Jaw: 2021 Position Statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons

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