Characteristics of patients with osteonecrosis of the jaw with oral versus intravenous bisphosphonate treatment

Abstract

Purpose This retrospective study was aimed to evaluate the clinical characteristics and treatment outcomes in patients with osteonecrosis of the jaw who were receiving oral versus intravenous (IV) bisphosphonate (BP). Materials and methods This retrospective study enrolled subjects who had been diagnosed with medication-related osteonecrosis of the jaw (MRONJ) during the period from July 2010 to June 2014. Information regarding the following demographic and clinical characteristics was collected: demographic data, administration route and type of BP, duration of BP medication, primary disease, number of involved sites, location of the lesion, number of surgeries, outcome of treatments, and laboratory test. All the patients were divided into oral and IV BP groups; and the between-group differences were compared. Results Total 278 patients were divided into two groups as per the route of BP administration. The proportion of oral BP-related MRONJ group were more dominant over IV BP group (oral BP, n = 251; IV BP, n = 27). In the IV BP group, the average dosing duration (31.4 months) was significantly shorter than that in the oral BP group (53.1 months) (P < 0.001). The average number of involved sites in the oral BP group (1.21 ± 0.48) was smaller than that in the IV BP group (1.63 ± 0.84) (P < 0.001). The average number of surgeries was higher in the IV BP group (1.65 ± 0.95) as compared to that in the oral BP group (0.98 ± 0.73) (P < 0.001). Outcome after the surgery for MRONJ after IV BP was poor than oral BP group. Conclusion IV administration of BP causes greater inhibition of bone remodeling and could lead more severe inflammation. Therefore, even if the duration of IV administration of BP is shorter than that of oral BP, the extent of the lesion could be more extensive. Therefore, the result suggests that the MRONJ after IV BP for cancer patients needs to be considered as different characteristics to oral BP group for osteoporosis patents.

Factors affecting quality of life in cancer patients with medication related osteonecrosis of the jaw- A cross sectional study- Part 1.

“…7,8,10 It has been suggested that MRONJ is less aggressive with smaller extent of lesion when oral bisphosphonates are used as compared intravenous counterparts, potentially yielding better global quality of life scores. 25,26 Within our cohort, we found a signi cant correlation between global health status of the patients and drugs linked to MRONJ as well as the route of administration. Cancer patients with MRONJ, who received zoledronic acid had lowest global health status scores.…”

Medication-related osteonecrosis: Literature review

“…McGowan K et al, Premoli A et al, Kaibuchia N et al, Lee S, affirm that the location with the greatest tendency to develop MRONJ is the mandible in the posterior sector, specifically in the molar area, which could be attributed to the decreased vascularity of the mandible (13) (33) (44) (48). However, Falinda et al, determined that the region with the greatest involvement of MRONJ was the maxilla, contrasting with the information expressed in previous studies.…”

Osteonecrosis of the Jaw Associated with Bisphosphonates Infusion for Treatment of Plasma Cell Myeloma—A Retrospective Observational Study of Northern Portuguese Population

“…A study in 2012, which evaluated patients with cancer and MRONJ, showed that inflammatory dental diseases were a risk factor in 50% of the cases [36]. On the other hand, the administration of IV bisphosphonates could cause a greater degree of inflammation as a result of their ability to inhibit bone remodeling [56]. However, since a common treatment of inflammatory dental disease is dental extraction, pre-existing dental disease may confuse the relationship between dental extraction and the risk for MRONJ.…”