Osteonecrosis of the jaw related to non-antiresorptive medications: a systematic review

Nicolatou‐Galitis, Ourania; Kouri, Maria; Papadopoulou, Erofili; Vardas, Emmanouil; Galiti, Dimitra; Epstein, Joel B.; Sharon, Elad; Campisi, Giuseppina; Tsoukalas, Nikolaos; Bektaş-Kayhan, Kıvanç; Tan, Winston; Body, Jean‐Jacques; Migliorati, Cesar A.; Lalla, Rajesh R.V.

doi:10.1007/s00520-018-4501-x

Cited by 90 publications

(78 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Herein, we report a case of medication-related osteonecrosis of the upper jaw after Bemcentinib regimen for the treatment of secondary acute myeloblastic leukemia. Clinical and radiographic findings were very similar to cases of MRONJ as previously described using Sunitinib [1][2][3] or other anti-angiogenetic substances [6,7]. We show clinical findings and review the literature.…”

Section: Introductionsupporting

confidence: 79%

Necrotizing periodontitis or medication-related osteonecrosis of the jaw (MRONJ) in a patient receiving Bemcentinib—a case report

Bumm

Folwaczny

Wölfle

2020

Oral Maxillofac Surg

View full text Add to dashboard Cite

Bemcentinib is a newly developed AXL inhibitor that is currently under investigation in phase II trails for the treatment of acute myeloblastic leukemia (AML). Clinical and radiographic findings in this case were very similar to cases of MRONJ in patients receiving Sunitinib or other anti-angiogenetic substances, assuming that Bemcentinib may cause similar oral side effects. We present a male 81-year-old patient with a manifestation of alveolar bone necrosis at the central upper incisors following a 2-month regimen with the AXL-inhibitor Bemcentinib, administered for the treatment of secondary acute myeloblastic leukemia (sAML). Due to the duration of less than 8 weeks, the osteonecrosis was diagnosed as necrotizing periodontitis, but the intraoral clinical and radiographic findings were also compatible with the differential diagnosis of medication-related osteonecrosis of the jaw (MRONJ, stage II). Following to discontinuation of Bemcentinib, the affected bone was surgically revised including the removal of a demarcated bone sequester under preventive antibiotic treatment (metronidazole 400 mg t.i.d.). We hypothesize that Bemcentinib might increase the susceptibility for osteonecrosis of the jaw, probably related to its antiangiogenic effects and the resulting modulation of host immune response. Based on the current observations, it can be assumed that oro-dental health might be significant also prior and during treatment with Bemcentinib for the prevention of MRONJ.

show abstract

Section: Introductionsupporting

confidence: 79%

Necrotizing periodontitis or medication-related osteonecrosis of the jaw (MRONJ) in a patient receiving Bemcentinib—a case report

Bumm

Folwaczny

Wölfle

2020

Oral Maxillofac Surg

View full text Add to dashboard Cite

show abstract

“…149,150 There is also an urgent need to define the characteristics of the increasingly reported cases of osteonecrosis of the jaw related to medications without known antiresorptive properties. 151,152 Patient-reported outcome data are needed, not only to help to establish which treatments are most effective but also to better understand the disease process. Although there is a higher risk of MRONJ in the oncology setting than in the osteoporosis setting, evidence suggests that the burden of disease may, paradoxically, be greater in the latter.…”

Section: Mronj and The Need For Multiprofessional Teamworkmentioning

confidence: 99%

“…Although there is a higher risk of MRONJ in the oncology setting than in the osteoporosis setting, evidence suggests that the burden of disease may, paradoxically, be greater in the latter. 152 A study suggested that MRONJ may lead to a significant deterioration in oral HRQoL, as measured by the Oral Health Impact Profile 14, driven largely by pain/discomfort and anxiety/depression. 153 Outcomes reported by patients and members of a care team can also provide a useful insight into health-related behavior.…”

Section: Mronj and The Need For Multiprofessional Teamworkmentioning

confidence: 99%

Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment

Nicolatou‐Galitis

Schiødt

Mendes

et al. 2019

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Self Cite

226

203

View full text Add to dashboard Cite

Skeletal complications caused by osteoporosis or bone metastases are associated with considerable pain, increased mortality, and reduced quality of life. Furthermore, such events place a burden on health care resources. Agents that prevent bone resorption, such as bisphosphonates or denosumab, can reduce the risk of skeletal-related events and are widely used in patients with osteoporosis or bone metastases of cancer. Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but potentially serious, adverse event associated with high cumulative doses of bisphosphonates or denosumab. However, MRONJ can be treated, and the likelihood of the development of this condition can be reduced through prophylactic dental care and the maintenance of good oral hygiene. Dentists, as part of a multiprofessional team, have a critical role in preventing MRONJ. This review describes the incidence and pathophysiology of MRONJ and provides guidance for dental practitioners with regard to the screening, prophylactic treatment, diagnosis, and management of patients with this condition. (Oral Surg Oral Med Oral Pathol Oral Radiol 2019;127:117À135) Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon condition that can occur after exposure to agents used to prevent bone complications, such as bisphosphonates or denosumab, or treatment with other agents, such as angiogenesis inhibitors. 1 In the majority of cases, MRONJ manifests as exposed bone in the maxillofacial region (Figure 1), although non-exposed MRONJ has also been recognized (Figure 2). 2-5 Bisphosphonates and denosumab are predominantly used to reduce the risk of skeletal complications in patients with bone loss, resulting from long-term cancer treatment or osteoporosis, and in patients with malignant bone disease. 6-8 Bisphosphonates are small molecules that dock in hydroxyapatite-binding sites on bone surfaces. When osteoclasts begin to resorb bisphosphonate-impregnated bone, the liberated bisphosphonates bind to farnesyl pyrophosphate synthase inside the osteoclasts, ultimately leading to apoptosis. 8-10 Denosumab is a fully human monoclonal antibody, which has a different mode of action from that of bisphosphonates. It targets and binds to the receptor activator of nuclear factor k-B (RANK) ligand (RANKL); in doing so it prevents the activation of RANK on the surface of osteoclasts and osteoclast precursors. Inhibition of the RANKLÀRANK interaction impedes osteoclast formation, function, and survival, thereby decreasing bone resorption. 11 MRONJ is more prevalent among patients receiving high cumulative doses of bisphosphonates or denosumab than in patients who receive lower doses. 12,13 The first cases Statement of Clinical Relevance Medication-related osteonecrosis of the jaw is a rare, but potentially serious, complication of treatment with bisphosphonates and denosumab. It is important for dentists to be aware of ways to identify and treat patients at risk of this condition.

show abstract

“…MRONJ is a potentially serious complication of anti‐resorptive (AR) treatment in patients with skeletal metastases due to various cancers as well as osteoporosis (Campisi et al, ). MRONJ may also develop in anti‐resorptive‐naive individuals exposed to a variety of anti‐angiogenic agents (Mohamed, Nielsen, & Schiodt, ; Nicolatou‐Galitis, Kouri, et al, ; Pimolbutr, Porter, & Fedele, ). MRONJ may lead to a reduced quality of life due to jaw bone infections, chronic pain, tooth loss, impaired function, and disfigurement.…”

Section: Introductionmentioning

confidence: 99%

Workshop of European task force on medication‐related osteonecrosis of the jaw—Current challenges

et al. 2019

View full text Add to dashboard Cite

Osteonecrosis of the jaw related to non-antiresorptive medications: a systematic review

Cited by 90 publications

References 58 publications

Necrotizing periodontitis or medication-related osteonecrosis of the jaw (MRONJ) in a patient receiving Bemcentinib—a case report

Necrotizing periodontitis or medication-related osteonecrosis of the jaw (MRONJ) in a patient receiving Bemcentinib—a case report

Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment

Workshop of European task force on medication‐related osteonecrosis of the jaw—Current challenges

Contact Info

Product

Resources

About