Antiresorptive treatment-associated ONJ

Abstract

Osteonecrosis of the jaw (ONJ) is a severe complication of therapy with antiresorptive agents (e.g. bisphosphonates and denosumab), which are used to manage bone metastases from cancer, to reduce the incidence of skeletal-related events. Available data indicate that 0-27, 5% of patients exposed to antiresorptive agents may develop ONJ, depending on the number of infusions and the duration of therapy. Besides antiresorptive therapy, a number of risk factors for osteonecrosis have been identified. Oral surgical procedures, tooth extractions and infection to the jawbones are considered the main risk factors for developing ONJ, when receiving antiresorptive therapy. However, a growing number of patients develop ONJ without apparent risk factors, raising concern for other predisposing factors. Jaw bone necrosis may be irreversible, resulting in a chronic disease with negative impact on the quality of patients' lives. The role of risk reduction strategies like meticulous dental screening and optimal oral hygiene is fundamental for preventing development of ONJ. ONJ is usually treated conservatively to relieve the symptoms and manage jaw bone necrosis. In certain cases, surgical intervention is required. Future research should emphasize individual predisposition to ONJ, more effective preventive measures and more efficient therapeutic procedures.

Zoledronate treatment duration is linked to bisphosphonate‐related osteonecrosis of the jaw prevalence in rice rats with generalized periodontitis

“…Medication‐related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse event characterized by persistent exposure of necrotic bone in the jaw (Ruggiero et al, ) in patients treated with potent anti‐resorptives (pARs) [e.g., nitrogen‐containing bisphosphonates, N‐BPs (Marx, ; Ruggiero et al, ), and receptor activator of NFκB ligand antibodies (Stopeck et al, ; Van den Wyngaert, Wouters, Huizing, & Vermorken, )]. More recently, MRONJ has been observed in patients with cancer taking anti‐angiogenic medication (e.g., vascular endothelial growth factor antibodies) (Carlson & Schlott, ; Eleutherakis‐Papaiakovou & Bamias, ; Fusco, Santini, Armento, Tonini, & Campisi, ; Khan et al, ; Ramirez, Lopez‐Pintor, Casanas, Arriba, & Hernandez, ; Voss, Poxleitner, Schmelzeisen, Stricker, & Semper‐Hogg, ). In ONJ cases in which the only systemically administered medication is an N‐BP, the term bisphosphonate‐related osteonecrosis of the jaw (BRONJ) may also be used.…”

“…Systemic administration of these medications is specified in the clinical definition of MRONJ as a requirement for a formal diagnosis (Ruggiero et al, ). However, local factors in the oral cavity, despite being absent from the formal definition of MRONJ, also increase risk and play a crucial role in the disease process (Aghaloo, Hazboun, & Tetradis, ; Aljohani et al, ; Carlson & Schlott, ; Eleutherakis‐Papaiakovou & Bamias, ; Filleul, Crompot, & Saussez, ; Hamadeh, Ngwa, & Gong, ; Khan et al, ; Marx, ; Otto et al, ; Voss et al, ; Yoneda et al, ).…”

“…Discrete oral procedures involving the dentoalveolar bone (e.g., tooth extraction) are considered the most common local oral factor associated with MRONJ and are estimated to occur in 52%–86% of MRONJ cases (Aghaloo et al, ; Aljohani et al, ; Carlson & Schlott, ; Eleutherakis‐Papaiakovou & Bamias, ; Filleul et al, ; Hamadeh et al, ; Khan et al, ; Marx, ; Otto et al, ; Ruggiero et al, ; Voss et al, ; Yoneda et al, ). Delaying the start of risk factor medications until surgical sites have healed, and ensuring appropriate perioperative management, including antibiotic coverage, are often effective means to prevent MRONJ associated with dentoalveolar surgery (Dimopoulos et al, ; Hoefert & Eufinger, ; Montefusco et al, ; Ripamonti et al, ; Vandone et al, ).…”

Medication Related Osteonecrosis of Jaw: A Medical Oncologist’s Perspective

“…In the local risk factors tooth extraction, dentoalveolar surgery, poor oral hygiene, jaw infections, dental implants and dental caries are to be looked for. In the systemic risk factors, apart from type, number and duration of BMA administration, anti-angiogenics, monoclonal antibodies, steroids, chemotherapy, RT, smoking, drinking, obesity, rheumatoid arthritis, hypocalcemia, hypoparathyroidism, osteomalacia, vitamin D deficiency, renal dialysis, anemia, and Paget's disease of bone and uncontrolled diabetes are important [32,33].…”

Bone health in cancer patients - An important clinical issue

“…Eleutherakis‐Papaiakovou and Bamias () examine osteonecrosis of the jaw (ONJ); this is a relatively uncommon but very important condition which arises from use of anti‐resorptive agents such as bisphosonates and denosumab. The paper emphasises the importance of risk reduction strategies, such as meticulous dental screening and optimal oral hygiene.…”