The progress of medication-related osteonecrosis of the jaw with conservative initial treatment: A 12-year retrospective study of 129 patients

Kaibuchi, Nobuyuki; Hoshi, Keika; Yamazaki, Ayame; Miyamoto-Sangu, Noriko; Akagi, Yuichi; Okamoto, Toshihiro

doi:10.1016/j.bonr.2021.101072

Cited by 14 publications

(10 citation statements)

References 21 publications

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“…In many cases it is the only treatment needed and achieves long-term symptom relief ( 94 , 206 , 207 ). Cure rates with conservative management are higher for OP than for cancer patients ( 207 ). Management includes the following:…”

Section: Prevention and Managementmentioning

confidence: 99%

Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organized by the ECTS

Anastasilakis

Pepe

Napoli

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Antiresorptive therapy significantly reduces fracture risk in patients with benign bone disease and skeletal-related events (SREs) in patients with bone metastases. Osteonecrosis of the jaw (ONJ) is a rare, but severe condition, manifested as necrotic bone lesion(-s) of the jaws. ONJ has been linked to the use of potent antiresorptive agents, termed as Medication Related ONJ (MRONJ). Methods A working group of the European Calcified Tissue Society (ECTS) and two experts performed an updated detailed review of existing literature on MRONJ incidence, characteristics, and treatment applied in bone diseases with variable severity of skeletal insult, ranging from osteoporosis to prevention of cancer treatment-induced bone loss and SREs in cancer patients with bone metastases. We aimed to identify the differences in various aspects of MRONJ among these distinct patient categories and provide recommendations on how to mitigate the risk and optimally manage MRONJ in each one of them. Results The risk for MRONJ is much higher in patients with advanced malignancies compared to those with benign bone diseases, because of the higher doses and more frequent administration of antiresorptive agents in individuals with compromised general health, along with co-administration of other medications that predispose to MRONJ. The overall risk for MRONJ is considerably lower than the benefits in all categories of patients. Conclusions The risk for MRONJ largely depends on the underlying bone disease and the relevant antiresorptive regimen applied. Physicians and dentists should keep in mind that the benefits of antiresorptive therapy far outweigh the risk for MRONJ development.

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Section: Prevention and Managementmentioning

confidence: 99%

Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organized by the ECTS

Anastasilakis

Pepe

Napoli

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…The goals of both conservative and surgical treatments are the same: control of pain or secondary infection and prevention of extension or development of the disease 5 . Numerous reports have emphasized the efficacy of surgical treatment 14–16,23,24 . Additionally, recent studies have reported that conservative therapy alone results in residual disease, and extensive surgery can be performed even at the early stages of MRONJ 25,26 .…”

Section: Discussionmentioning

confidence: 99%

“…5 Numerous reports have emphasized the efficacy of surgical treatment. [14][15][16]23,24 Additionally, recent studies have reported that conservative therapy alone results in residual disease, and extensive surgery can be performed even at the early stages of MRONJ. 25,26 In a systematic review, the cure rates of patients who underwent conservative treatment, minimal debridement, and extensive surgery were 33%, 74%, and 84%, respectively.…”

Section: Multivariate Analysismentioning

confidence: 99%

“…The cure rate is less than 50% for conservative treatment, while that surgical treatment ranges from 60% to 80%. Moreover, previous studies have reported that surgical intervention is the first choice of treatment for MRONJ 14–16 . However, there is still no consensus for the appropriate treatment strategy for MRONJ because decision‐making for treatment is patient‐specific, and details of procedures or appropriate timing of the operation are still unknown.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, previous studies have reported that surgical intervention is the first choice of treatment for MRONJ. [14][15][16] However, there is still no consensus for the appropriate treatment strategy for MRONJ because decision-making for treatment is patient-specific, and details of procedures or appropriate timing of the operation are still unknown. The Multinational Association of Supportive Care in Cancer, International Society of Oral Oncology, and American Society of Clinical Oncology (MASCC/ISOO/ASCO) recommend conservative treatment as the initial approach for MRONJ.…”

mentioning

confidence: 99%

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Risk factors associated with prognosis of patients with medication‐related osteonecrosis of the jaw

Tadokoro,

Hasegawa,

Takeda

et al. 2023

Head & Neck

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ObjectivesMedication‐related osteonecrosis of the jaw (MRONJ) is a severe adverse effect of antiresorptive and/or antiangiogenic agents. As the treatment application for MRONJ is controversial, we aimed to identify the risk factors for poor prognosis and to help determine appropriate management.MethodsThis study included 119 patients. Relevant clinical data were obtained for all the patients. In computed tomography images, osteosclerosis, osteolysis, cortical perforation (buccal or lingual), periosteal reaction, and sequestration were evaluated.ResultsMultivariate analyses showed statistically significant associations between poor prognosis in patients with MRONJ and conservative treatment alone (hazard ratio [HR] 1.89), osteolysis (HR 4.67), and the absence of sequestration (HR 5.33).ConclusionsConservative treatment alone without clear objectives needs to be avoided, and osteolytic change could be the criteria for surgical intervention. As the boundary between the lesion and vital bone is indistinct, we recommend extensive surgery in cases with unpredictable sequestration.

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Application of mesenchymal stromal cell sheets to prevent medication-related osteonecrosis of the jaw with titanium implants in rats

Nishimaki,

Kaibuchi,

Washio

et al. 2024

Odontology

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The progress of medication-related osteonecrosis of the jaw with conservative initial treatment: A 12-year retrospective study of 129 patients

Cited by 14 publications

References 21 publications

Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organized by the ECTS

Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organized by the ECTS

Risk factors associated with prognosis of patients with medication‐related osteonecrosis of the jaw

Application of mesenchymal stromal cell sheets to prevent medication-related osteonecrosis of the jaw with titanium implants in rats

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