Osteonecrosis of the Jaws (ONJ) after Bisphosphonate Treatment in Patients with Multiple Myeloma: Decreasing ONJ Incidence after Adoption of Preventive Measures

Abstract

Bisphosphonates (BPs) are administered to Multiple Myeloma (MM) patients with bone lytic lesion. Osteonecrosis of the Jaw (ONJ) is a complication reported since 2003 in patients treated with intravenous (IV) BPs such as zoledronic acid and pamidronate, with 6%–26.3% frequency in early literature series, before some preventive measures were recommended. We evaluated the occurrence of ONJ with and without dental preventive measures in MM patients treated with BPs in our centre between 1996 and 2015. Since 2005, MM patients (already under treatment or before treatment) underwent a baseline mouth assessment (dental visit, Rx orthopantomography, and eventual tooth avulsion or dental care if necessary) and were followed by a multidisciplinary team. We reviewed the charts of 119 MM patients receiving IV BPs, classified into 3 groups: (a) “historic group” (21 patients who had started BP treatment in years before the awareness of ONJ); (b) “screening group” (20 patients starting BPs without baseline evaluation); and (c) “prevention group” (78 patients starting therapy only after baseline preventive assessment and eventual dental care measures). ONJ was observed in 3/21 patients (14.2%) from group a, in 2/20 patients (10%) from group b, and in no patients from group c (0%). Notably, the median number of IV BP administrations decreased after 2005. Our data confirmed a meaningful reduction of ONJ risk in MM patients treated with BPs if preventive measures are applied. Both implementation of prevention measures and reduction of cumulative doses of IV BPs could have contributed to a decreased incidence of ONJ.

Drug holiday patterns and bisphosphonate‐related osteonecrosis of the jaw

“…As suggested previously, the benefits of continuation of BP therapy in a population with high fracture risk (Black et al, ) may outweigh the risk of developing ONJ. Furthermore, if dental interventions are inevitable, cautious approaches, including preventive dental screening to identify any possible infection or inflammation (Catania et al, ) and refining surgical protocols for dental surgery (Scoletta et al, ), may be considered. Finally, clinical decisions on the length of BP holidays and dental surgery should be based on a risk‐benefit analysis considering individual patient characteristics.…”

A retrospective study on the incidence of medication-related osteonecrosis of the jaws (MRONJ) associated with different preventive dental care modalities

“…Findings in the present study are comparable for the patients who did not have a check-up with an oral cavity specialist (i.e., 50 patients in group 0, and 5 vs. 21 belonging to groups 1–2–3–4) [ 33 ]. A meaningful reduction in the risk of MRONJ among multiple myeloma patients treated with BPs was confirmed if preventive measures had been adopted [ 17 ]. In our sample, MRONJ was observed in 3/21 patients (14.2%) who started BP treatment at a time before the risk of MRONJ had come to light; 2/20 patients (10%) who started taking BPs without any preventive dental check-up; and none of the patients whose BP therapy started only after preventive dental care measures (0%) [ 17 ].…”

“…The main target of primary prevention in patients who are to be administered drugs potentially associated with the onset of MRONJ is to achieve and maintain a state of oral and dento-periodontal health and perfect oral hygiene, thereby eliminating local risk factors [18]. It has been demonstrated that preventive dental screening and treatment reduces the incidence of MRONJ [17,19,20]. Appropriate preventive oral surgery and conservative endodontic and prosthetic measures have been published [21][22][23][24][25].…”

“…Risk factors for MRONJ are both local (dental infections, tooth extractions, oral surgery, ill-fitting dentures) and systemic (number of administrations of medication; duration of medical treatments; and, in the case of BPs, type of drug, as the risk of MRONJ is higher for zoledronic acid vs. pamidronate vs. other BPs) [ 17 ].…”

Management von medikamentenassoziierten Kiefernekrosen – Ergebnisse einer Literaturanalyse neuester Studien im Vergleich zu bewährten Strategien

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