Osteonecrosis of the Jaws (ONJ) related to bisphosphonates (BPs) or denosumab is a concern for osteoporosis and Rheumatoid Arthritis (RA) patients. In a context of increasing prescription rate of BPs and denosumab amid those patients in the last decade, incidence and/or prevalence of ONJ in these categories of patients remain uncertain, with lack of solid epidemiologic data from observational studies. As an almost unique experience, the present work provides a multicenter, retrospective overview of ONJ in non malignant disease patients over a timespan of 15 years (Jan 1st 2004 - Dec 31st, 2018) from the oral care centers of Piedmont and Valle d’Aosta. In detail, data from 165 patients (8 M, 157 F) were acquired. Mean age was of 74 (38-91) years, with more than half (64.2%) of patients diagnosed with ONJ between 70 and 89 years. Underlying diseases were osteoporosis (80%), RA (5.4%), osteoporosis and RA (3.6%), other bone disorders (11%). Treatment administered were alendronate (51.8%), ibandronate (12.3%), zoledronic acid (6.8%), others (29.1%). Concerning the latter, since 2014, 7 cases were related to denosumab (60 mg every 6 months), of which 5 to denosumab alone, 2 in patients switched from BPs to denosumab. Sites of ONJ were mandible (67%), maxilla (25%), mandible and maxilla (7%). Finally, an overall rise of ONJ occurrence was observed, with a median of 7 (2-13) yearly ONJ cases in the 2004-2010 period, gone up to 11.5 (6-24) yearly ONJ events in the 2011-2018 period. Such worrisome trend underlines the importance of eventual prevention measures and recurring assessment of oral health to reduce ONJ risk in non-malignant disease patients.
The aim of this communication is to present our protocol of management and treatment and to discuss our experience in the management of MRONJ patient at the Division of Maxillofacial Surgery at Novara Hospital in the last twelve years.
A revision of all patients affected by MRONJ that were diagnosed between January 2009 and December 2020 was performed. On the whole, 109 patients with a mean age of 70 years were included: 75 patients had mandibular ONJ, whereas 27 maxillary ONJ and the remaining 7 patients mandibular and maxillary ONJ. 54% of patients was classified as Stage 1, 30% as Stage 2, and 16% as Stage 3. In 87 cases, patients underwent, in addition to medical therapy, surgical interventions of curettage, sequestrectomy, or bone resection; the remaining 22 patients were just administered medical therapy.
Advanced Stage MRONJ can be efficiently managed by surgery combined with medical therapy.
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