Systemic comorbidities are associated with medication‐related osteonecrosis of the jaws: Case–control study

Abstract

Objectives Medication‐related osteonecrosis of the jaws (MRONJ) is a serious condition developed in up to 15% of patients who take antiresorptive medications. Its underlying pathogenesis remains unclear. The association between systemic comorbidities and MRONJ was investigated. Subjects and Methods A case–control study was conducted in Brisbane, Australia. Hospital records were used to identify 68 cases of MRONJ between January 2003 and March 2017. Each case was individually matched to three controls (204 in total) according to sex, age, primary disease, and type and duration of antiresorptive therapy. Data on patient demographic, social and clinical characteristics were collected. Systemic comorbidities and medications were quantified as a comorbidity–polypharmacy score (CPS). Associations were investigated using conditional logistic regression. Results The CPS calculated for patients who developed MRONJ (mean ± SD = 20.2 ± 5.1) was significantly higher than for controls (12.9 ± 4.6). Multivariable analysis determined a significant relationship between CPS and the presence of MRONJ (OR = 1.5; 95% CI = 1.3, 1.8, p < 0.001). Conclusions Patients with multiple systemic comorbidities and high levels of polypharmacy were more likely to develop MRONJ. The CPS is a simple and effective tool to quantify the risk of MRONJ attributed to a patient's systemic condition and should be considered in conjunction with the patient's oral health to assess the overall risk of MRONJ.

Medication‐related osteonecrosis of the jaw: Analysing the range of implicated drugs from the Australian database of adverse event notifications

“…Aside from cancer and osteoporosis, there are an increasing number of other conditions with case reports of MRONJ, such as rheumatoid arthritis (RA) 14,39,40 . Several implicated drugs in this study, including adalimumab, cyclophosphamide, etanercept, methotrexate and rituximab, have indications for RA as well as other auto‐immune conditions.…”

“…36,37 Aside from cancer and osteoporosis, there are an increasing number of other conditions with case reports of MRONJ, such as rheumatoid arthritis (RA). 14,39,40 Several implicated drugs in this study, including adalimumab, cyclophosphamide, etanercept, methotrexate and rituximab, have indications for RA as well as other auto-immune conditions. The disease process of RA is characterised by high levels of proinflammatory cytokines that leads to increased bone resorption, progressive joint destruction, osteoporosis and increased fracture risk.…”

“…The incidence of MRONJ associated with bisphosphonates or denosumab use in cancer patients is 1–15%, and for patients with osteoporosis it is estimated at between 1 in 10 000 and 1 in 100 000 per year of use 12 . A case–control study showed that systemic comorbidities and polypharmacy of any kind again increased risk of MRONJ 14 …”

“…12 A case-control study showed that systemic comorbidities and polypharmacy of any kind again increased risk of MRONJ. 14 While it is well-documented that MRONJ is associated with bisphosphonates and denosumab, there are a growing number of MRONJ case reports associated with other medications, including antiangiogenic agents. 1,15,16 This is mostly due to 2 reasons as stated by Fusco and colleagues 17 :…”

Multiple myeloma and pulmonary aspergillosis: dental treatment prior to chemotherapy and management of post extraction complications

“…Furthermore, a study by McGowan et al found the incidence of MRONJ in patients on multiple medications with systemic comorbidities was higher. 10 Hence intensive dental preventative advice and careful planning and monitoring of these patients after starting medications that can cause MRONJ, must be at the forefront of care.…”