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. 2022 Mar;30(3):2341-2348.
doi: 10.1007/s00520-021-06634-7. Epub 2021 Nov 5.

Risk evaluation of denosumab and zoledronic acid for medication-related osteonecrosis of the jaw in patients with bone metastases: a propensity score-matched analysis

Hiroaki Ikesue  1 , Kohei Doi  2 , Mayu Morimoto  2 , Masaki Hirabatake  2 , Nobuyuki Muroi  2 , Shinsuke Yamamoto  3 , Toshihiko Takenobu  3 , Tohru Hashida  2
Affiliations

Risk evaluation of denosumab and zoledronic acid for medication-related osteonecrosis of the jaw in patients with bone metastases: a propensity score-matched analysis

Hiroaki Ikesue et al. Support Care Cancer. 2022 Mar.

Abstract

Purpose: This study evaluated the risk of medication-related osteonecrosis of the jaw (MRONJ) in patients with cancer who received denosumab or zoledronic acid (ZA) for treating bone metastasis.

Methods: The medical records of patients were retrospectively reviewed. Patients who did not undergo a dental examination at baseline were excluded. The primary endpoint was a comparison of the risk of developing MRONJ between the denosumab and ZA groups. Propensity score matching was used to control for baseline differences between patient characteristics and compare outcomes for both groups.

Results: Among the 799 patients enrolled, 58 (7.3%) developed MRONJ. The incidence of MRONJ was significantly higher in the denosumab group than in the ZA group (9.6% [39/406] vs. 4.8% [19/393], p = 0.009). Multivariate Cox proportional hazards regression analysis revealed that denosumab treatment (hazard ratio [HR], 2.89; 95% confidence interval [CI], 1.65-5.25; p < 0.001) and tooth extraction after starting ZA or denosumab (HR, 4.26; 95% CI, 2.38-7.44; p < 0.001) were significant risk factors for MRONJ. Propensity score-matched analysis confirmed that the risk of developing MRONJ was significantly higher in the denosumab group than in the ZA group (HR, 2.34; 95% CI, 1.17-5.01; p = 0.016).

Conclusion: The results of this study suggest that denosumab poses a significant risk for developing MRONJ in patients treated for bone metastasis, and thus these patients require close monitoring.

Keywords: Denosumab; Osteonecrosis of the jaw; Risk factor; Zoledronic acid.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study diagram. BMA, bone-modifying agent; ZA, zoledronic acid
Fig. 2
Fig. 2
Cumulative incidence of MRONJ in patients receiving denosumab or ZA for bone metastasis. The cumulative incidences of developing MRONJ were compared between the denosumab and ZA groups (a) before and (b) after propensity score matching of the cohort. MRONJ, medication-related osteonecrosis of the jaw; ZA, zoledronic acid
See this image and copyright information in PMC

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