Factors Exacerbating Clinical Symptoms and CT Findings in Patients with Medication-Related Osteonecrosis of the Jaw Receiving Conservative Therapy: A Multicenter Retrospective Study of 53 Cases

Abstract

Recent reports have shown that better treatment outcomes are obtained with surgical therapy in patients with medication-related osteonecrosis of the jaw (MRONJ) than with conservative therapy. However, conservative treatment is selected due to factors such as old age and poor general condition. Conservative therapy aims to relieve symptoms and prevent lesion exacerbation; however, the lesion may expand rapidly in some cases. This study investigated the clinical and imaging findings of 53 MRONJ patients undergoing conservative therapy, and the changes in the clinical findings and the lesion enlargement on CT imaging were examined. Improved clinical findings and no worsening of the imaging findings were considered overall comprehensive treatment successes. Among the 53 patients, the clinical symptoms disappeared or improved in 15 patients, whereas they worsened in 6. In contrast, osteolytic lesion enlargement occurred in 17 patients. The comprehensive treatment outcome of conservative therapy was successful in 12 patients and unsuccessful in 41 patients. The periosteal reaction was significantly correlated with poor comprehensive treatment outcomes (p = 0.038). MRONJ lesions may advance, even if they appear to improve clinically while undergoing conservative treatments. Patients, especially those with periosteal reactions, must be closely followed up with CT examinations, regardless of the clinical findings.

Oral-Health-Related Quality of Life in Patients with Medication-Related Osteonecrosis of the Jaw: A Prospective Clinical Study

“…This corroborates previous reports showing that surgical treatment improves OHRQoL in patients with stages I and II MRONJ [ 32 , 33 ]. These findings are also in line with those of previous studies showing that standard surgical interventions are more effective than conservative treatment [ 34 , 35 ].…”

Improvement of Quality of Life after Surgical Treatment of Patients with MRONJ: A Prospective Analysis Using the SF-12 and OHIP-14 Questionnaires

“…Therapeutic success, defined as stage 0 at the end of the observation period of 6 months, however, occurred in only 13 patients (48%). This has also been shown in other studies, in which surgical intervention achieved better therapeutic results than conservative therapy [ 17 , 18 ]. The concept of therapeutic success is subjective and individualized for each patient.…”

Comparing the Influence of Surgical and Conservative Therapy on Quality of Life in Patients with Early-Stage Medication-Related Osteonecrosis of the Jaw—A Prospective Longitudinal Study

“…Two recent systematic reviews [ 29 , 30 ] on this topic identified a total of 12 studies that examined quality of life in MRONJ patients [ 10 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Another literature search by our research group identified six more papers [ 42 , 43 , 44 , 45 , 46 , 47 ]. Ten of the studies assess OHRQoL (using the questionnaires OHIP 14, OHIP 49, QLQ-OH 15, QLQ-HN35) [ 10 , 32 , 33 , 36 , 37 , 39 , 41 , 42 , 43 , 44 ], while twelve looked at general health-related QoL, pain or psychological outcome measures (using the questionnaires: EORTC QLQ-C30, SF 12, UWQoL, EQ-5D, Duke health profile, VAS, QLQ-ELD14, SWLS) [ 31 , 32 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 44 , 47 ].…”

“…In the present work, we evaluated the influence of conservative and surgical treatment on stage I MRONJ patients’ QoL. Unfortunately, the available studies [ 10 , 31 , 34 , 36 , 37 , 38 , 39 , 42 , 44 , 46 ] on this subject differ greatly with regard to the methods of treatment, indications for the respective therapy and the stages of MRONJ. Most authors examined the influence of conservative or surgical therapy according to the recommendation of the AAOMS from 2014 [ 14 ].…”