A comparison of the cone beam computed tomography findings in medication-related osteonecrosis of the jaws related to denosumab versus bisphosphonates: an observational pilot study

Pichardo, Sarina E.C.; Broek, Frans Willem ten; Fiocco, Marta; Appelman‐Dijkstra, Natasha M.; Merkesteyn, J.P.R. van

doi:10.1016/j.oooo.2019.09.010

Cited by 16 publications

(11 citation statements)

References 23 publications

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“…Less frequently, sequestration, intraosseous air bubbles, and cortical lysis have been observed. These signs are very similar to those found in the literature [21][22][23] except for intraosseous air bubbles.…”

Section: Radiographic Findingssupporting

confidence: 90%

“…Between January 2010 and December 2018, 246 patients (155 female and 91 male) were treated with Xgeva ® for bone metastases (120 mg Denosumab every 4 weeks) or giant cell bone tumor (120 mg Denosumab every 4 weeks with 2 additional doses of 120 mg in the first month of treatment). The median follow-up time was 16 months (IQR [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]). At the last follow-up, 38 patients (24 female and 14 male) developed MRONJ.…”

Section: Resultsmentioning

confidence: 99%

“…In total, in this study, bone sequestration was observed on CBCT in less than a quarter of the cases. Bone sequestration and cortical lysis appear to be less frequent in patients with osteonecrosis of the jaw with denosumab than with bisphosphonates [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

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A Comparison of the Clinical and Radiological Extent of Denosumab (Xgeva®) Related Osteonecrosis of the Jaw: A Retrospective Study

Assili

Dolivet

Salleron

et al. 2021

JCM

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Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive medication. The aim of this study was to evaluate the incidence of denosumab-related osteonecrosis of the jaw and to compare the clinical and radiological extent of osteonecrosis. A retrospective study of patients who received Xgeva® at the Institut de Cancérologie de Lorraine (ICL) was performed. Patients for whom clinical and radiological (CBCT) data were available were divided into two groups: “exposed” for patients with bone exposure and “fistula” when only a fistula through which the bone could be probed was observed. The difference between clinical and radiological extent was assessed. The p-value was set at 0.05, and a total of 246 patients were included. The cumulative incidence of osteonecrosis was 0.9% at 6 months, 7% at 12 months, and 15% from 24 months. The clinical extent of MRONJ was significantly less than their radiological extent: in the “exposed” group, 17 areas (45%) were less extensive clinically than radiologically (p < 0.001) and respectively 6 (67%) for the “fistula” group (p < 0.031). It would seem that a CBCT is essential to know the real extent of MRONJ. Thus, it would seem interesting to systematically perform a CBCT during the diagnosis of MRONJ, exploring the entire affected dental arch.

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Section: Radiographic Findingssupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

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A Comparison of the Clinical and Radiological Extent of Denosumab (Xgeva®) Related Osteonecrosis of the Jaw: A Retrospective Study

Assili

Dolivet

Salleron

et al. 2021

JCM

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“…It was recently reported that ONJ in patients receiving denosumab or BPs differed regarding histopathological and radiologic features, and in some studies, also in terms of outcome. ( 35‐38 ) Denosumab‐associated ONJ demonstrated significantly lower numbers of osteocytes per area, ( 35 ) whereas persistent bone resorption lacunae on the necrotic bone surface were found only in BP‐associated ONJ. ( 36 ) Further, the radiologic features of denosumab‐related ONJ may be different from those of BP‐associated ONJ, with fewer sequesters and less cortical lysis.…”

Section: Discussionmentioning

confidence: 99%

Risk of Osteonecrosis of the Jaw Under Denosumab Compared to Bisphosphonates in Patients With Osteoporosis

Everts‐Graber

Lehmann

John‐Patrik

et al. 2020

Journal of Bone and Mineral Research

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Osteonecrosis of the jaw (ONJ) is a rare but serious adverse event associated with antiresorptive treatment. There is little evidence regarding the incidence of ONJ among patients with osteoporosis who are treated with denosumab versus bisphosphonates (BPs). The aim of this study was to determine the risk of ONJ in a real‐world population. Subjects who underwent at least one dual‐energy X‐ray absorptiometry (DXA) examination were included in the osteoporosis register of the Swiss Society of Rheumatology between January 1, 2015, and September 30, 2019. Statistical analyses included incidence rates, rate ratios, and hazard ratios for ONJ, considering sequential therapies and drug holidays as covariates. Among 9956 registered patients, 3068 (89% female, median age 69 years [63 to 76]) were treated with BPs or denosumab for a cumulative duration of 11,101 and 4236 patient‐years, respectively. Seventeen cases of ONJ were identified: 12 in patients receiving denosumab at the time of ONJ diagnosis and 5 in patients receiving oral or intravenous BP therapy. The diagnosis of ONJ was confirmed by independent and blinded maxillofacial surgeons, using the American Association of Oral and Maxillofacial Surgeons case definition of ONJ. The incidence of ONJ per 10,000 observed patient‐years was 28.3 in patients receiving denosumab and 4.5 in patients with BP‐associated ONJ, yielding a rate ratio of 6.3 (95% confidence interval [CI] 2.1 to 22.8), p < 0.001. Nine of 12 patients who developed ONJ during denosumab treatment had been pretreated with BPs, but none of the 5 patients with BP‐related ONJ had previously received denosumab. The risk of ONJ was higher in patients receiving denosumab therapy compared with BPs (hazard ratio 3.49, 95% CI 1.16 to 10.47, p = 0.026). Previous BP therapy before switching to denosumab may be an additional risk factor for ONJ development. © 2021 American Society for Bone and Mineral Research (ASBMR).

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“…In contrast, Heim et al 37 reported that the bone density values were significantly higher in patients taking BPs than in those taking denosumab. Pichardo et al 38 reported that in patients with DRONJ, sequestra and lysis of the cortical border of the jaw were significantly less common than in patients with BRONJ. Subperiosteal bone formation did not differ between the groups.…”

Section: Does Mronj In Oncologic and Osteoporotic Patients Show Diffementioning

confidence: 99%

Several issues regarding the diagnostic imaging of medication-related osteonecrosis of the jaw

2020

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A comparison of the cone beam computed tomography findings in medication-related osteonecrosis of the jaws related to denosumab versus bisphosphonates: an observational pilot study

Cited by 16 publications

References 23 publications

A Comparison of the Clinical and Radiological Extent of Denosumab (Xgeva®) Related Osteonecrosis of the Jaw: A Retrospective Study

A Comparison of the Clinical and Radiological Extent of Denosumab (Xgeva®) Related Osteonecrosis of the Jaw: A Retrospective Study

Risk of Osteonecrosis of the Jaw Under Denosumab Compared to Bisphosphonates in Patients With Osteoporosis

Several issues regarding the diagnostic imaging of medication-related osteonecrosis of the jaw

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