Medication-Related Osteonecrosis of the Jaw: A Cross-Sectional Survey among Urologists in Switzerland, Germany, and Austria

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a potentially preventable adverse side effect of mainly antiresorptive drugs. MRONJ is expected to become a growing clinical problem due to the aging population and the increasing number of patients requiring antiresorptive agents. Knowledge and awareness about MRONJ and elimination of the oral and dental risk factors before starting antiresorptive therapy (AR) are fundamental to reducing the incidence of MRONJ. In urology, ARs are used primarily in patients suffering from bone metastases due to prostate cancer and to prevent cancer-treatment-induced bone loss (CTIBL) in prostate cancer patients receiving endocrine therapy. This postal survey aimed to evaluate disease-related knowledge and awareness about implementing oral examinations for patients starting AR among Swiss, German, and Austrian urologists. A total of 176 urologists returned the completed questionnaire, yielding a response rate of 11.7%. Of the respondents, 44.9% (n = 79) and 24.4% (n = 43) stated that they give more than five first-time prescriptions of denosumab and of intravenous or oral bisphosphonates per year, respectively. Only 14.8% (n = 26) of the participating urologists had never encountered MRONJ cases related to BPs. Of the participants, 89.8% (n = 158) had implemented referrals to dentists for oral examination before initiating AR. The mean percentage of correct answers regarding the knowledge about MRONJ was 70.9% ± 11.2%. In contrast to previous surveys on MRONJ among physicians, this study showed that the participating urologists were sufficiently informed about MRONJ, as reflected by the high number of participants implementing preventive dental screenings.

Anti‐resorptive therapy and MRONJ. A survey of the Italian Society of Periodontology and Implantology

“…While several previous reports highlighted that a low proportion of prescribers still do not routinely refer their patients to dentists before initiating AR therapy (Taguchi et al, 2016), a recent survey surprisingly showed that 90% of a sample of urologists from Austria and Germany declare they implemented referrals to dentists for oral examination before initiating AR (Calderaro et al, 2023).…”

Treatment of bone metastases from solid tumors with bone-modifying agents: a web survey of Italian oncologists investigating patterns of practice drug prescription and prevention of side effects

“…In our survey the question about prostate cancer did not distinguish between BMAs at high doses and with monthly administration (as usual in metastatic castration-resistant disease) or BMAs at low doses and/or with delayed administration (recommended for hormone-sensitive metastatic cancer, as well as for prevention or treatment of cancer treatment-induced bone loss (CTIBL)). This issue should be further investigated in a more specific survey involving both urologists and oncologists, as well as specialists treating CTIBL [ 13 , 17 , 20 , 25 , 28 , 42 ].…”

“…Guidelines and recommendations show some heterogeneity and uncertainty about the choice of treatment drug (bisphosphonates versus denosumab), optimal treatment duration (one versus 2 years or indefinite treatment), de-escalation and delayed dosing schedules (e.g., zoledronic acid every 3 months instead of monthly administration) [ 3 – 5 , 8 , 10 ], as well as the management of side effects, such as MRONJ and hypocalcemia [ 6 – 9 , 11 ]. According to recent surveys and studies conducted in Europe and North America, the attitudes of prescribing physicians, as well as patients’ preferences and real-life practice patterns, are not fully homogeneous [ 12 – 28 ].…”