Medication-Related Osteonecrosis of the Jaws: Considerations on a New Antiresorptive Therapy (Denosumab) and Treatment Outcome after a 13-Year Experience

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients receiving antiresorptive therapies for bone neoplastic localizations and osteoporosis. The aim of this study was to evaluate the clinicopathological features of MRONJ in a cohort of patients treated by new antiresorptive drugs (denosumab) and the corresponding outcome after 13-year maximum follow-up. Overall, 244 patients affected by MRONJ were treated from 2003 to 2015. After clinical and radiological examinations, all lesions were staged according to a dimensional staging system and then surgically treated. All the denosumab-related lesions were classified as stage II or III, thus requiring a more or less invasive surgical approach, despite the results of many recent studies, which suggested a conservative medical approach with early resolution for MRONJ in patients on denosumab. In the current series, 86.9% of treated lesions showed complete clinical and radiological healing, while 13.1% recurred; all recurrences were detected in patients who could not interrupt chemotherapy, steroids, and/or antiresorptive drugs administration due to their general conditions. In conclusion, all oral specialists should be aware of the MRONJ risk among patients taking new antiresorptive drugs; moreover, our protocol based on surgical treatment guided by dimensional staging could be considered effective in view of the low recurrence rate.

Medication‐related osteonecrosis of the jaw: Surgical or non‐surgical treatment?

“…In previous studies (Favia et al., ; Franco et al., ), we concluded that surgery was the gold standard for MRONJ management, leaving non‐surgical approaches to those patients who, for distinct health reasons, were ineligible for surgery. In the current study, we have compared surgical and non‐surgical treatment outcomes of MRONJ and, overall, 131 lesions from 106 patients; nevertheless, due to the limited sample size of the non‐surgical, G2 patients (21 patients with 24 lesions), statistical analyses were unsuitable.…”

“…In previous studies (Favia et al, 2016;Franco et al, 2014), we concluded that surgery was the gold standard for MRONJ management, leaving non-surgical approaches to those patients who, for distinct health reasons, were ineligible for surgery. In the current study,…”

“…Finally, the treatment strategy was individually established for each patient as deemed clinically appropriate. As reported in previous studies (Favia, Tempesta, Limongelli, Crincoli, & Maiorano, ; Franco et al., ), surgical treatment was considered the gold standard for the management of MRONJ but, considering that patients affected by MRONJ are often elderly, with multiple morbidities, and presenting several local or general risk factors, a safe surgical approach was not always possible. Consequently, the patients were divided into two groups: Group 1 (G1), consisting of patients who could safely experience surgical treatments, and Group 2 (G2), consisting of patients for whom surgery was not considered completely safe or who could not stop their cancer‐related therapies and, therefore, required non‐surgical management.…”

“…Finally, the treatment strategy was individually established for each patient as deemed clinically appropriate. As reported in previous studies (Favia, Tempesta, Limongelli, Crincoli, & Maiorano, 2016;Franco et al, 2014), surgical treatment was considered the gold standard for the management of MRONJ but, considering that patients affected by MRONJ are often elderly, with multiple morbidities, and presenting several local or general risk factors, a safe surgical approach was not always possible. Consequently, the patients were divided into two groups:…”

Concomitant Central Giant Cell Granuloma and Aneurysmal Bone Cyst in a Young Child

“…Moreover, these drugs have frequent local or systemic side effects such as osteonecrosis and growth deficiencies [10–13]. …”