Relationship between disease stage and renal function in bisphosphonate-related osteonecrosis of the jaw

Abstract

ObjectivesBisphosphonate is the primary cause of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Bisphosphonates are eliminated from the human body by the kidneys. It is anticipated that bisphosphonate levels in the body will increase if the kidney is in a weak state or if there is systemic disease that affects kidney function. The aim of this study was to analyze the relevance of renal function in the severity of BRONJ.Materials and MethodsNinety-three patients diagnosed with BRONJ in Pusan National University Dental Hospital from January 2012 to December 2014 were included in this study. All patients underwent a clinical exam, radiographs, and serologic lab test, including urine analysis. The patient's medical history was also taken, including the type of bisphosphonate drug, the duration of administration and drug holiday, route of administration, and other systemic diseases. In accordance with the guidelines of the 2009 position paper of American Association of Oral and Maxillofacial Surgeons, the BRONJ stage was divided into 4 groups, from stage 0 to 3, according to the severity of disease. IBM SPSS Statistics version 21.0 (IBM Co., USA) was used to perform regression analysis with a 0.05% significance level.ResultsBRONJ stage and renal factor (estimated glomerular filtration rate) showed a moderate statistically significant correlation. In the group with higher BRONJ stage, the creatinine level was higher, but the increase was not statistically significant. Other factors showed no significant correlation with BRONJ stage. There was a high statistically significant correlation between BRONJ stage and ‘responder group’ and ‘non-responder group,’ but there was no significant difference with the ‘worsened group.’ In addition, the age of the patients was a relative factor with BRONJ stage.ConclusionWith older age and lower renal function, BRONJ is more severe, and there may be a decrease in patient response to treatment.

Adjuvant therapies in the management of medication‐related osteonecrosis of the jaws: Systematic review

“…They are associated with bioavailability of the drug in the bone matrix. In patients with cancer receiving high doses of intravenous zoledronate or denosumab, the risk of MRONJ increases with higher doses and longer treatment duration, although there is evidence that even short‐term administration of BP may cause progression to severe disease …”

Bone Marrow Multipotent Mesenchymal Stromal Cells as Autologous Therapy for Osteonecrosis: Effects of Age and Underlying Causes

“…Chronic kidney diseases have been linked to ON, particularly of the jaw, with aging and low renal function [ 196 ] in addition to children with chronic renal failure [ 197 ]. Different mechanisms have been proposed linking chronic kidney diseases to ON, including using bisphosphonate and immunosuppressants after renal transplantation [ 198 ].…”