Relevant factors for treatment outcome and time to healing in medication-related osteonecrosis of the jaws – A retrospective cohort study

Martins, Ana Silva; Correia, João André; Salvado, Francisco; Caldas, C; Santos, Nuno Rebelo dos; Capelo, António; Palmela, Paulo

doi:10.1016/j.jcms.2017.07.014

Cited by 28 publications

(31 citation statements)

References 27 publications

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“…MRONJ was confirmed mostly in females (65.6%) which is previously reported [9]. One of the reasons which could explain the frequency of disease in females could be the higher incidence of breast cancer in females and skeletal metastasis.…”

Section: Discussionmentioning

confidence: 54%

Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies

Petrović

Jelovac

Antic

et al. 2019

BioMed Research International

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This retrospective cohort study aims to describe characteristics of patients with MRONJ, to identify factors associated with MRONJ development, and to examine variables associated with favourable outcome. Totally 32 patients were followed and observed: 21 females and 11 males, in the age range 35-84 in the period from 2009 to 2018. Clinical, radiological examination (Orthopantomograph and CBCT) and biopsy were performed in order to achieve diagnosis. Demographic and clinical variables were taken into consideration: sex, age, primary disease, medication type, mode of delivery, anatomic location, drug treatment duration, timing of tooth extraction, chemotherapy, presence of bone metastasis, aetiology of MRONJ, disease stage, and treatment modality. MRONJ developed under osteoporosis and malignant disease in 11 and 21 patients, respectively. MRONJ development was triggered by tooth extraction or trauma in 30 out of 32 cases, whereas the two patients developed MRONJ spontaneously. Stages I, II, and III were confirmed in 5 (16%), 18 (58%), and 9 (28%) patients, respectively. Mandible was affected in 23 (72%) patients. MRONJ was treated in our department by conservative and surgical modality. In this study we found that 65% of all patients were classified in the cured/improvement group and 35% in the stable/progression group. The female gender, osteoporosis as primary disease, oral regime intake, shorter period on BPs, earlier stage of disease, and specific anatomic localisation (frontal and premolar maxilla) were factors associated with better response to therapy and favourable clinical outcome. Comprehensive treatment protocol and further randomized studies are necessary for further improvements.

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Section: Discussionmentioning

confidence: 54%

Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies

Petrović

Jelovac

Antic

et al. 2019

BioMed Research International

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“…In previous studies performed on the ONJ in patients medicated with bisphosphonates it was observed that the lesions occurred mostly in the mandible (68.1%), and to a lesser extent in the maxilla (27.7%) or in both jaws (4.2%) (27). Regarding the ONJ lesions of this study, 54% of cases occurred in the mandible and 33% in the maxilla.…”

Section: Discussionmentioning

confidence: 97%

“…It has been suggested that the local risk factors of ONJ associated with sunitinib are similar to those of ONJ associated with bisphosphonates. Among the dental risk factors, it should be noted that tooth extraction is the most frequent triggering event (27). But there are other precipitating local factors such as other types of dentoalveolar surgery, the continued trauma to the mucosa (such as that produced by a removable prosthesis), the presence of exostosis, oral infection, the presence of periodontitis and poor oral hygiene (4,9,20,25).…”

Section: Discussionmentioning

confidence: 99%

“…There are also a number of systemic risk factors for ONJ, including the duration of administration of antiresorptive drugs, the dose, the simultaneous use of antiangiogenic and antiresorptive drugs, treatment with chemotherapy or concomitant corticosteroids, or diseases such as diabetes (16,27). Since the introduction of targeted therapies, the life expectancy of patients with metastatic renal cell cancer has tripled, but this also leads to prolonged exposure to treatments such as bisphosphonates and anti-angiogenic drugs that increase the risk of ONJ (9,21).…”

Section: Discussionmentioning

confidence: 99%

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Osteonecrosis of the jaws produced by sunitinib: a systematic review

Vallina¹,

Ramı́rez²,

Torres³

et al. 2019

Med Oral

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Background Tyrosine kinase receptor family is involved in tumor growth, pathological angiogenesis and the progression (metastasis) of cancer. Sunitinib (Sutent®) inhibits members of the tyrosine kinase receptor family affecting the induction of angiogenesis and tumor progression. It is not clear if sunitinib increases the risk of osteonecrosis of the jaws (ONJ). The aim of this study was to carry out a systematic review about ONJ related to sunitinib, describing existing cases and possible associated risk factors. Material and Methods The PubMed/MEDLINE and Cochrane Library databases were searched without date restriction up to September 2018. We included prospective and retrospective observational studies, cross-sectional studies, clinical cases and series of cases, involving only human subjects. The methodological quality of the studies was assessed using The Joanna Briggs Institute (JBI) and Newcastle-Ottawa tools. Results A total of 13 studies fulfilled our inclusion criteria of which 7 were clinical cases, 5 case series and a retrospective study. All the articles were published between 2009 and 2018. Of the 102 patients treated with sunitinib analyzed in this study, 58 developed ONJ, being or having been treated with sunitinib and bisphosphonates or exclusively with sunitinib. Conclusions In this systematic review, we found an increase of ONJ in patients who are medicated with other drugs different than bisphosphonates and denosumab. It is necessary that dentists, oral and maxillofacial surgeons as well as oncologists know the risk of ONJ that these antiresorptive drugs could have. There is a need to continue researching in this field with the aim of an increasing knowledge in this area and creating an adequate protocol of action for this population. Key words: Medication-related osteonecrosis of the jaws, osteonecrosis of the jaws, sunitinib, systematic review.

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“…The following criteria for clinical healing were used (adapted from [ 28 ]): Short-term healing—A patient was defined as “healed at short-term”, if presenting, for at least 1 month after sequestrectomy or spontaneous exfoliation of necrotic bone, the following clinical picture: absence of exposed necrotic bone or bone that can be probed through a fistula; absence of purulent drainage; absence of edema and stimulated pain; complete mucosal coverage of the surgical site. Long-term healing—A patient was defined as “healed at long-term”, if presenting the same clinical picture described above but lasting for at least 3 months after sequestrectomy or spontaneous exfoliation of bone sequestration.…”

Section: Methodsmentioning

confidence: 99%

Conservative Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Retrospective Cohort Study

et al. 2021

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Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of bisphosphonates and anti-resorptive drugs prescribed for treatment of severe osteoporosis, Paget’s disease, and bone malignancies. The aim of this study was to evaluate the clinical outcome of a combined pharmacological and surgical management strategy on patients affected by MRONJ. Materials and methods: Medical records of patients with MRONJ were retrospectively examined to collect clinical history data. Conservative management included an initial pharmacological phase with antibiotics and antiseptic agents, followed by surgical intervention to remove bone sequestrum. Primary outcomes were healing from MRONJ at short term (1 month after surgery) and at longer term (3 months after surgery). Secondary outcome was assessment of recurrences at longer-term follow-up. Results: Thirty-five patients were included in the study with mean follow-up of 23.86 ± 18.14 months. Seven cases showed spontaneous exfoliation of necrotic bone during pharmacological therapy, which in one case did not require any further intervention. At 1-month posttreatment, 31 out of 35 (88.5%) patients showed complete healing. The 25 patients who were followed for at least 3 months revealed a healing rate of 92% (23/25). Recurrences occurred in 7 patients out 23 who showed the long-term healing, after a mean period of 7.29 ± 3.45 months. The prognostic score (University of Connecticut Osteonecrosis Numerical Scale—UCONNS) was significantly higher (p = 0.01) in patients with poor healing as compared to complete healing, both at 1 and 3 months posttreatment. Conclusions: A MRONJ treatment approach based on a combined pharmacological and surgical treatment strategy showed a high rate of healing and few recurrences.

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Relevant factors for treatment outcome and time to healing in medication-related osteonecrosis of the jaws – A retrospective cohort study

Cited by 28 publications

References 27 publications

Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies

Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies

Osteonecrosis of the jaws produced by sunitinib: a systematic review

Conservative Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Retrospective Cohort Study

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