The Effect of Antiresorptive Drug Holidays on Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Meta-Analysis

Abstract

The objective of this study is to evaluate the effectiveness of discontinuing high-dose antiresorptive (AR) therapy in reducing the risk of medication-related osteonecrosis of the jaw (MRONJ) in patients treated with AR medications and undergoing dentoalveolar surgery or tooth extractions.The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. A literature search was conducted using the databases MEDLINE, Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception till the 1st of April, 2022. Both observational and interventional studies that evaluated the effect of AR drug holiday in the development of MRONJ in patients receiving AR medications and who require dentoalveolar surgical procedures were included. Trials published as abstracts, case reports, case series, non-systematic reviews, and others were excluded. All findings were reported as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the methodological quality assessment, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to evaluate the quality of the evidence.Eight articles (6808 subjects) were included for analysis. Of the participants, 4847 cases (drug holiday group) were compared to 1961 controls (non-drug holiday group). Based on the random effects model, the pooled summary OR was 0.73 (95% CI: 0.51-1.06) for the drug holiday group compared to the non-drug holiday group. In other words, the drug holiday group was not significantly different from the non-drug holiday group in the development of MRONJ following a tooth extraction procedure (p = 0.10). The statistical heterogeneity was low across all studies (I 2 = 13%, p = 0.33).Within the limits of the available evidence, our findings revealed that drug holidays with AR will not minimize the risk of MRONJ and thus cannot be advised. It may be possible to arrive at more definitive conclusions from large prospective studies and randomized trials of good quality.

Unveiling Medication-Related Osteonecrosis of the Jaw: A Rapid Review of Etiology, Drug Holidays, and Treatment Strategies

“…Complementing these findings, another study systematically reviewed the literature, including both observational and interventional studies, to assess the effect of an AR drug holiday on the development of MRONJ. This extensive analysis encompassed 6808 subjects, comparing cases from the drug holiday group with controls from the non-drug holiday group [22]. The results revealed no significant difference between the groups in the development of MRONJ, leading to the conclusion that AR drug holidays do not minimize the risk of MRONJ, and their recommendation as a preventive measure is not substantiated by the current evidence [22].…”

“…This extensive analysis encompassed 6808 subjects, comparing cases from the drug holiday group with controls from the non-drug holiday group [22]. The results revealed no significant difference between the groups in the development of MRONJ, leading to the conclusion that AR drug holidays do not minimize the risk of MRONJ, and their recommendation as a preventive measure is not substantiated by the current evidence [22].…”

Unveiling Medication-Related Osteonecrosis of the Jaw: A Narrative Review of Etiology, Drug Holidays, and Treatment Strategies

“…Complementing these findings, another study systematically reviewed the literature, including both observational and interventional studies, to assess the effect of an AR drug holiday on the development of MRONJ. This extensive analysis encompassed 6808 subjects, comparing cases from the drug holiday group with controls from the non-drug holiday group [52]. The results revealed no significant difference between the groups in the development of MRONJ, leading to the conclusion that AR drug holidays do not minimize the risk of MRONJ, and their recommendation as a preventive measure is not substantiated by the current evidence [52].…”

“…This extensive analysis encompassed 6808 subjects, comparing cases from the drug holiday group with controls from the non-drug holiday group [52]. The results revealed no significant difference between the groups in the development of MRONJ, leading to the conclusion that AR drug holidays do not minimize the risk of MRONJ, and their recommendation as a preventive measure is not substantiated by the current evidence [52].…”

Enhancing the Oral Rehabilitation and Quality of Life of Bisphosphonate-Treated Patients: The Role of Dental Implants

“…However, a recent meta-analysis conducted by Aboalela et al (2022) [ 20 ] analyzed eight articles with 6808 subjects and concluded that there was no significant difference in the development of BRONJ following a tooth extraction procedure between the drug holiday group and the non-drug holiday group. The study concluded that drug holidays with antiresorptive (AR) medications will not minimize the risk of BRONJ and cannot be advised based on the available evidence.…”