Relationship between oral condition and risk factors for jaw osteonecrosis in patients with hip fractures

Abstract

Purpose : Antiresorptive agents, such as bisphosphonates, are useful for the prevention of the recurrence of hip fractures. However, their administration has a risk of antiresorptive agent-related osteonecrosis of the jaw (ARONJ), and risk factors include poor oral hygiene. It is difficult for an orthopedic surgeon to examine a patient's oral condition thoroughly. This study evaluated the relationship between risk factors for ARONJ and intraoral findings in hip fracture patients. Materials and Methods : We evaluated 79 patients (average age of 82.2 years) with hip fracture surgery who underwent an oral assessment by dentists. The risk assessments of the intraoral findings were classified into four levels (levels 0-3), with levels 2 and 3 requiring dental treatment intervention. Data that could be extracted as risk factors of ARONJ were also examined. Results : Level 1 was found most frequently (54.4%), followed by level 0 (35.4%), level 2 (8.9%), level 3 (1.3%). The area under the receiver operating characteristic curve for the number of risk factors for the two groups (dental treatment intervention required and unnecessary) and oral findings were 0.732. When the cut-off value was set to two risk factors, the specificity and sensitivity was 53.5% and 87.5%. Conclusions : For hip fracture patients with a more than 2 risk factors, dental visits are recommended to prevent ARONJ. This is a useful evaluation method that can be used to screen for ONJ from data obtained from other risk factors, even if it is difficult to evaluate the oral condition in hospitals where dentists are absent.

Potential Relationship between Poor Oral Hygiene and MRONJ: An Observational Retrospective Study

“…Vandone et al in 2012 observed that after establishing preventive oral care measures, a lower number of cases of ONJ were observed [ 18 ], and Krimmel et al observed that drugs were not the only cause, but oral and dental health were crucial elements in the onset of this pathology [ 19 , 20 ]. Dental evaluation is evidently essential to avoid MRONJ, especially because the drugs involved in this disease are often the first therapeutical option for metabolic and oncologic patients, mostly keeping in mind the moderate incidence of this side effect [ 21 ]. At the same time, a paper by Al Abdullateef et al suggested that careful information about this kind of complication should be given both to dentists and patients, to avoid or delay the onset of complications [ 22 ].…”