Osteonecrosis of the jaw and use of bisphosphonates in adjuvant breast cancer treatment: a metanalysis

Abstract

To estimate the cumulative randomized evidence for the overall incidence of bisphosphonates induced jaw osteonecrosis in adjuvant treatment of breast cancer. Systematic review and meta-analysis of randomized clinical trials. Trials were located through PubMed, ISI, Cochrane Library, and major cancer scientific meetings searches. We identified 15 studies reporting data on osteonecrosis of the jaw. A total of 10,694 randomized women were included, of whom 5,312 received bisphosphonates and 5,382 received either placebo or no treatment.

Bisphosphonate-related osteonecrosis of the jaw in randomized clinical trials

“…They concluded that prospective epidemiological efforts, such as those made by academic researchers, are probably the most reliable source of information regarding ONJ incidence [2]. Thus, Mauri et al [1] may report on a low incidence of ONJ in those patients receiving bisphosphonates as adjuvant treatment of breast cancer, simply because the RCTs at study have not been able to detect ONJ cases, similarly to the previous experience with RCTs and ONJ [2]. 3.…”

“…One should read with great interest the paper of Mauri et al [1] in the Online First section of Breast Cancer Research and Treatment. The paper presents a meta-analysis of the existing randomized clinical trials (RCTs) for the overall incidence of bisphosphonates-induced jaw osteonecrosis (ONJ) in adjuvant treatment of breast cancer.…”

“…3. Mauri et al [1] do not comment on whether the included RCT protocols integrated a clinical dental evaluation. It appears that integration of clinical dental evaluation in the study protocol is critical to accurately detect ONJ cases, while scrutinizing dental records may be insufficient [3].…”

“…This argument further suggests that RCTs may have failed in detecting every ONJ case. Mauri et al [1] discuss that the eligible trials were neither prospectively designed nor adequately powered to measure the risk of ONJ as a primary outcome. 4.…”

“…Mauri et al [1] discuss that the occurrence of ONJ appeared to be lower among patients receiving A. Kyrgidis (&) Aristotle University of Thessaloniki, Thessaloniki, Greece e-mail: akyrgidi@gmail.com bisphosphonates different than zoledronate.…”