Osteonecrosis of Jaw (Onj) in Patients With Osteoporosis and Other Non-Malignant Diseases in Piedmont and Aosta Valley 2004-2018

Abstract

Osteonecrosis of the Jaws (ONJ) related to bisphosphonates (BPs) or denosumab is a concern for osteoporosis and Rheumatoid Arthritis (RA) patients. In a context of increasing prescription rate of BPs and denosumab amid those patients in the last decade, incidence and/or prevalence of ONJ in these categories of patients remain uncertain, with lack of solid epidemiologic data from observational studies. As an almost unique experience, the present work provides a multicenter, retrospective overview of ONJ in non malignant disease patients over a timespan of 15 years (Jan 1st 2004 - Dec 31st, 2018) from the oral care centers of Piedmont and Valle d’Aosta. In detail, data from 165 patients (8 M, 157 F) were acquired. Mean age was of 74 (38-91) years, with more than half (64.2%) of patients diagnosed with ONJ between 70 and 89 years. Underlying diseases were osteoporosis (80%), RA (5.4%), osteoporosis and RA (3.6%), other bone disorders (11%). Treatment administered were alendronate (51.8%), ibandronate (12.3%), zoledronic acid (6.8%), others (29.1%). Concerning the latter, since 2014, 7 cases were related to denosumab (60 mg every 6 months), of which 5 to denosumab alone, 2 in patients switched from BPs to denosumab. Sites of ONJ were mandible (67%), maxilla (25%), mandible and maxilla (7%). Finally, an overall rise of ONJ occurrence was observed, with a median of 7 (2-13) yearly ONJ cases in the 2004-2010 period, gone up to 11.5 (6-24) yearly ONJ events in the 2011-2018 period. Such worrisome trend underlines the importance of eventual prevention measures and recurring assessment of oral health to reduce ONJ risk in non-malignant disease patients.