Antiresorptive agent-related osteonecrosis of the jaw in osteoporosis patients from Asian countries

Abstract

Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) was first reported in oncology patients in 2003 and subsequently in osteoporosis patients in 2004. Since oral surgical procedures, such as tooth extraction, are also considered one of the major risk factors for ONJ, there is confusion among physicians, dentists, and patients—particularly osteoporosis patients currently taking BPs—regarding the safety of remaining on therapy surrounding these procedures. Many papers about BP-related ONJ (BRONJ) have been published to date. In addition to BRONJ, recent studies have reported an association between ONJ and the antiresorptive therapy denosumab (Dmab; a RANKL-inhibitor). BRONJ and Dmab-related ONJ are together referred to as antiresorptive agent-related ONJ (ARONJ). The pathogenesis of ARONJ still remains unknown. It is forecasted that there will be an increased incidence of patients with osteoporotic fractures and an increased number of prescriptions for antiresorptive agents in Asia in the future. However, prescriptions for antiresorptives for osteoporosis may be restricted in the Asian population as the occurrence of ARONJ may be higher as compared with those in other countries. In this review, we focused on the following topics as it pertains to the Asian osteoporotic population: the oral condition specific for osteoporosis patients; definition, staging, prevalence and incidence of ARONJ; imaging modalities for ARONJ; specific risk factors for ARONJ; prevention strategies for ARONJ, and; cooperation between physicians and dentists in the prevention of ARONJ. Ideally, the Asian Federation of Osteoporosis Societies would cooperate with one another and find more population-specific evidence for the prevention of ARONJ.

Risk comparison of osteonecrosis of the jaw in osteoporotic patients treated with bisphosphonates vs. denosumab: a multi-institutional retrospective cohort study in Taiwan

“…Among previous studies in osteoporosis patients in Asia, the closest value reported was 2.83 (per 1000 person-years), which was reported in the National Taiwan University study by Chiu [ 43 ]. However, remarkable differences existed in other Asian studies, with reported values ranging from 0.08 to 2.8 (per 1000 person-years) [ 16 ]. Therefore, the value obtained in our study was within a reasonable range in Asia.…”

“…Risk factors for MRONJ include age [ 10 ], sex, comorbidities (diabetes mellitus [DM] [ 5 ], chronic kidney disease [CKD], anemia [ 11 ], hyperthyroidism [ 12 ], hypothyroidism, rheumatoid arthritis, periodontal disease [ 11 , 13 ]), dental treatment regimens (tooth extractions [ 11 ], ill-fitting dentures), and drugs (corticosteroid [ 14 ], antiangiogenic agents [bevacizumab and sunitinib] [ 15 ]). The incidence of MRONJ among patients using BPs injections has been reported as 2 to 15% [ 16 ]. In a survey study of more than 13,000 Kaiser Permanente members, the prevalence of MRONJ in osteoporotic patients receiving long-term oral BP therapy was reported as 0.1% (10 cases per 10,000), which increased to 0.21% (21 cases per 10,000) in patients who had been taking oral BPs for more than 4 years [ 17 ].…”

“…Moreover, early studies focused on European and North American countries, which differ from Asian countries in terms of race, economic condition, medical status, and patient-related factors. Indeed, a recent study by Taguchi [ 16 ] revealed that the incidence of MRONJ is higher in Asian countries, highlighting the importance of conducting large-scale research on this issue in the Asian region [ 38 – 43 ].…”

Medication-Related Osteonecrosis of the Jaws (MRONJ) in Children and Young Patients—A Systematic Review

“…It was described that the development of MRONJ in patients with osteoporosis is related to suppuration, use of bisphosphonate, tooth extraction, and anemia [ 96 ]. Others showed that dental extractions, dental implants, and apical or periodontal surgery are the main factors involved in MRONJ [ 97 ]; additional risk factors such as dental prostheses with poor adaptation, excessive chewing force, poor oral hygiene, periodontal disease, and morphological bone irregularities have been related to MRONJ [ 98 ]. These conditions are absent in children and adolescents, and the masticatory force is lower in this group, showing another protective condition against MRONJ [ 99 ].…”

Expert opinion about osteonecrosis of the jaw

“…In this issue, review upon jaw necrosis related to antiresorptive agent such as bisphosphonate and denosumab was impressive as it relates the occurrence of the jaw bone necrosis to the oral health, not to the antiresorptive agent itself [1] . It is the infectious oral conditions, not antiresorptive agent itself that matters in the incidence of the jaw bone necrosis with the patients on bisphosphonate as an antiresorptive therapy, according to the authors.…”