Possible association of methotrexate use with osteonecrosis of the jaw: Systematic review

Milosavljević, Marko; Jovanović, Milica; Folić, Marko; Živić, Miloš; Zdravković, Dejan; Veličković, Stefan; Janković, Slobodan M.

doi:10.1016/j.jormas.2022.03.012

Cited by 4 publications

(2 citation statements)

References 34 publications

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“…There are no studies in the literature that show a relation between the only administration of methotrexate and the MRONJ [50]. Only one case report described a possible correlation between adalimumab and MRONJ [21].…”

Section: Discussionmentioning

confidence: 99%

Medication-Related Osteonecrosis of the Jaw: A Case Report of an Unusual Side Effect of Adalimumab

Sisalli,

Giordano,

Chiacchio

et al. 2023

Case Reports in Dentistry

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Background. Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse drug reaction characterized by progressive bone destruction and necrosis of mandibular and/or maxillary jaw bone that occurs in patients undergoing treatments with antiresorptive drugs such as bisphosphonates or denosumab, antiangiogenic agents such as bevacizumab, or other kinds of monoclonal antibodies such as rituximab and ipilimumab, for different oncologic and nononcologic diseases. The aim of this study was to report a case of MRONJ in a patient affected by rheumatoid arthritis disease in treatment with adalimumab. Case Presentation. A 70-year-old female patient affected by rheumatoid arthritis (RA), who had been undergoing adalimumab (40 mg subcutaneous injection) every two weeks for 5 years, with no history of antiresorptive or antiangiogenic agent administration, came to our attention for intraoral necrotic bone exposures of the anterior mandible. After drug withdrawal and antibiotic cycles, the patient underwent surgical treatment with bone resection and debridement of necrotic tissues. After an observation period of 8 months, a complete healing without signs of recurrence was detected.Conclusions. Based on this study, a correlation between adalimumab and MRONJ is possible. Therefore, we believe that an oral cavity examination should be done in every patients, before starting therapy with adalimumab, to possibly avoid MRONJ onset. Further studies are required to confirm the role of adalimumab in MRONJ.

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Section: Discussionmentioning

confidence: 99%

Medication-Related Osteonecrosis of the Jaw: A Case Report of an Unusual Side Effect of Adalimumab

Sisalli,

Giordano,

Chiacchio

et al. 2023

Case Reports in Dentistry

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“…Bisphosphonates (BPs) and denosumab are currently the most widely prescribed anti‐resorptive medications for metabolic bone diseases, bone malignancies, and bone metastases to reduce skeletal‐related events (Body, 2012; Drake et al, 2008; Gul et al, 2016; Hernlund et al, 2013). Methotrexate (MTX) and corticosteroids (CS) are also known to alter bone metabolism and reported to contribute to the development of medication‐related osteonecrosis of the jaw (MRONJ) (Henien et al, 2017; Milosavljevic et al, 2022; Weinstein, 2012). This review aimed to explore the relationship between dental implant failure and the intake of medications that affect bone metabolism.…”

Section: Introductionmentioning

confidence: 99%

Effect of agents affecting bone homeostasis on short‐ and long‐term implant failure

Jung,

Ryu,

Shim

et al. 2023

Clinical Oral Implants Res

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ObjectivesTo review the current evidence on the relationship between agents that affect bone homeostasis and dental implant failures.Materials and MethodsElectronic searches for bisphosphonates, denosumab, methotrexate, corticosteroids, romosozumab, sunitinib, and bevacizumab were performed using PubMed, MEDLINE (OVID), EMBASE (OVID), Cochrane Central Register of Controlled Trials (Cochrane Library), Cochrane Oral Health Group Trials Register (Cochrane Library) and Web of Science (Thomson Reuters). Manual searches were also conducted to complement the digital searches for recent issues.ResultsPrevious publications suggested that bisphosphonates do not compromise the survival of dental implants. However, one study documented an increased risk of implant failure in patients who had received high‐dose of intravenous bisphosphonate therapy after implant rehabilitation. There has been an issue of MRONJ around implants in patients who have successfully received implant therapy before and after antiresorptive therapy, leading to late implant failure. Despite evidence on the detrimental effects of denosumab, methotrexate and corticosteroids on bone metabolism, their role in implant survival is not conclusive.ConclusionsAt present, there is insufficient evidence to establish a potential connection between agents that affects bone homeostasis and implant failure. However, some studies have reported negative results for implant therapy. In addition, implant‐related sequestration in patients who received anti‐resorptive therapy, despite of successful osseointegration, is also noticeable. Although limited studies are available at present, clinicians should still carefully consider the potential hazards and take appropriate precautions to minimize the risks associated with the medications and implant therapy.

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Atypical presentation of medication-related osteonecrosis of the jaw in a young male patient undergoing chemotherapy for acute lymphoblastic leukemia

Bayram,

Fattahzade,

Uzay

et al. 2023

Oral Oncology Reports

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Possible association of methotrexate use with osteonecrosis of the jaw: Systematic review

Cited by 4 publications

References 34 publications

Medication-Related Osteonecrosis of the Jaw: A Case Report of an Unusual Side Effect of Adalimumab

Medication-Related Osteonecrosis of the Jaw: A Case Report of an Unusual Side Effect of Adalimumab

Effect of agents affecting bone homeostasis on short‐ and long‐term implant failure

Atypical presentation of medication-related osteonecrosis of the jaw in a young male patient undergoing chemotherapy for acute lymphoblastic leukemia

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