Workshop of European task force on medication‐related osteonecrosis of the jaw—Current challenges

Schiødt, Morten; Otto, Sven; Fedele, Stefano; Bedogni, Alberto; Nicolatou‐Galitis, Ourania; Guggenberger, Robert; Herlofson, Bente Brokstad; Ristow, Oliver; Kofod, Thomas

doi:10.1111/odi.13160

Cited by 110 publications

(141 citation statements)

References 47 publications

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“…(Yarom, Fedele, Lazarovici, & Elad, ). Infection was suggested to initiate bone necrosis, prior to dental extraction by others (Bollete et al, , Schiodt, et al, ). Disturbed bone remodeling, infection, altered immunity, soft tissue toxicity, and inhibition of angiogenesis are included in the evidence‐based mechanisms of the pathophysiology of MRONJ.…”

Section: Discussionmentioning

confidence: 99%

“…Alveolar bone histological necrosis was prospectively documented in 31 of 108 (28.7%) feasible biopsies at the time of extraction (Schiodt, Vadhan‐Raj, et al, ). The European Task Force suggested that cases of MRONJ believed to have been triggered by dental extractions might represent cases of non‐exposed MRONJ that had developed because of dental/periodontal infection, prior to extraction (Schiodt, et al ).…”

Section: Discussionmentioning

confidence: 99%

“…Structural alterations of the trabecular bone, which can be diagnosed using CT scans, were reported to characterize the early stages of MRONJ and could assist to the differentiation between alveolar bone infection and early stage of MRONJ (Bedogni et al, ). Biopsy is needed to confirm the presence of bone necrosis in cases of clinical or radiological suspicion of non‐exposed bone MRONJ (Schiodt, et al, ). The documentation of histological bone necrosis, in this study, further highlighted that treating dental infections during BTA therapy is crucial to minimize the risk of MRONJ (Nicolatou‐Galitis et al, ; Otto et al, ; Otto et al, ).…”

Section: Discussionmentioning

confidence: 99%

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Alveolar bone histological necrosis observed prior to extractions in patients, who received bone‐targeting agents

et al. 2020

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Objective We reported the alveolar bone histology prior to dental extractions in cancer patients, who received bone‐targeting agents (BTA). Subjects and Methods Fifty‐four patients were included. Patients underwent extractions, and bone biopsies were taken. Results Extractions were performed due to pain, swelling, purulence, fistula, and numbness, not responding to treatment, in 40 patients (group A); extractions due to asymptomatic, non‐restorable teeth, were performed in 14 patients (group B). Complete alveolar jaw bone histological necrosis was observed in 28 of 40 (70%) patients of group A and none of group B (p < .001). The development of clinical osteonecrosis (MRON) was assessed in 44 patients; 10 patients, who were also treated with Low Level Laser Treatments‐LLLT, were excluded from this analysis, as the alternative therapies were a confounding factor. Twelve patients, with alveolar bone histological necrosis prior to extraction, developed medication‐related osteonecrosis of the jaw (MRONJ) compared with two patients with vital or mixed vital/non‐vital bone (p < .0007). BTAs >1 year and concurrent targeted therapy were also significantly associated with MRONJ (p = .016 and p = .050). Conclusion Pain, swelling, purulence, fistula, and numbness were significantly associated with complete bone histological necrosis prior to extractions and increased MRONJ development. Research is justified to explore whether histological necrosis represents an early stage of osteonecrosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Alveolar bone histological necrosis observed prior to extractions in patients, who received bone‐targeting agents

et al. 2020

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“…However, up to one-quarter of patients experiencing MRONJ present with a non-exposed form [15], which should be recognized and treated similarly to exposed MRONJ [16]. Patients presenting with MRONJ with non-exposed bone were not historically formally diagnosed with the condition [15,17,18]. This prompted the AAOMS to include "bone that can be probed through a fistula" as a criterion for MRONJ in 2014 [14].…”

Section: Diagnosis Of Mronj and Patient Identificationmentioning

confidence: 99%

“…This prompted the AAOMS to include "bone that can be probed through a fistula" as a criterion for MRONJ in 2014 [14]. The AAOMS requirement of at least 8 weeks' observation for MRONJ manifestation may not be necessary [17]. These points are important to keep in mind when assessing for MRONJ.…”

Section: Diagnosis Of Mronj and Patient Identificationmentioning

confidence: 99%

Preventing, identifying, and managing medication-related osteonecrosis of the jaw: a practical guide for nurses and other allied healthcare professionals

Drudge-Coates

Wyngaert

Schiødt

et al. 2020

Support Care Cancer

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Background Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent, but potentially serious, adverse event that can occur after exposure to bone-modifying agents (BMAs; e.g., bisphosphonates, denosumab, and antiangiogenic therapies). BMAs are typically used at higher doses to prevent skeletal-related events in cancer patients and at lower doses for osteoporosis/ bone loss. MRONJ can cause significant pain, reduce quality of life, and can be difficult to treat, requiring a multiprofessional approach to care. Methods We reviewed the literature and guidelines to summarize a practical guide on MRONJ for nurses and other allied healthcare professionals. Results While there is a risk of MRONJ with BMAs, this should be considered in relation to the benefits of treatment. Nurses and other allied healthcare professionals can play a key role alongside physicians and dentists in assessing MRONJ risk, identifying MRONJ, counseling the patient on the benefit-risk of BMA treatment, preventing MRONJ, and managing the care pathway of these patients. Assessing patients for MRONJ risk factors before starting BMA treatment can guide preventative measures to reduce the risk of MRONJ. Nurses can play a pivotal role in facilitating multiprofessional management of MRONJ by communicating with patients to ensure compliance with preventative measures, and with patients' physicians and dentists to ensure early detection and referral for prompt treatment of MRONJ. Conclusions This review summarizes current evidence on MRONJ and provides practical guidance for nurses, from before BMA treatment is started through to approaches that can be taken to prevent and manage MRONJ in patients receiving BMAs.

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A Drug Holiday Reduces the Frequency and Severity of Medication-Related Osteonecrosis of the Jaw in a Minipig Model

Otto

Pautke

Arens

et al. 2020

Journal of Bone and Mineral Research

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Treatment of medication-related osteonecrosis of the jaw (MRONJ) is challenging and no clear consensus has been achieved. This study investigated preventive measures recommended for tooth extractions under antiresorptive (AR) treatment and the role of discontinuation of AR therapy to avoid the onset of MRONJ in a minipig model. Thirty-six Göttingen minipigs were divided into four groups. Group 1 (negative control): tooth extractions but no zoledronate (ZOL). Group 2 (positive control): weekly ZOL infusions for 12 weeks followed by tooth extractions without wound management followed by 8 weeks of ZOL treatment. Group 3: weekly ZOL infusions for 12 weeks followed by tooth extractions; surgical wound management (resection of sharp bone edges, mucoperiosteal coverage); and continuation of ZOL infusions for 8 weeks plus antibiotic treatment. Group 4: 12 weeks of ZOL infusions followed by a drug holiday for 6 weeks. Tooth extractions with preventive wound management followed by antibiotic treatment for 8 weeks but no ZOL infusions. Jawbones were subjected to macroscopic, radiological (CT and micro-CT) and histopathological investigations. No clinical cases of MRONJ were observed in the negative group, in the positive control all animals developed MRONJ. Group 3 developed MRONJ in 83% of cases. With a drug holiday, 40% developed MRONJ in areas of tooth extraction. This is the first large animal model that reduces the occurrence of MRONJ following tooth extraction by the implementation of a drug holiday combined with antibiotic prophylaxis and smoothening of sharp bony edges.

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Workshop of European task force on medication‐related osteonecrosis of the jaw—Current challenges

Cited by 110 publications

References 47 publications

Alveolar bone histological necrosis observed prior to extractions in patients, who received bone‐targeting agents

Alveolar bone histological necrosis observed prior to extractions in patients, who received bone‐targeting agents

Preventing, identifying, and managing medication-related osteonecrosis of the jaw: a practical guide for nurses and other allied healthcare professionals

A Drug Holiday Reduces the Frequency and Severity of Medication-Related Osteonecrosis of the Jaw in a Minipig Model

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