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. 2022 Mar;26(3):2839-2852.
doi: 10.1007/s00784-021-04261-4. Epub 2021 Nov 23.

Risk factors associated with onset of medication-related osteonecrosis of the jaw in patients treated with denosumab

Alexander Wick  1 , Philipp Bankosegger  2 , Sven Otto  3 , Bettina Hohlweg-Majert  4 , Timm Steiner  5 , Florian Probst  2 , Oliver Ristow  6 , Christoph Pautke  2   4
Affiliations

Risk factors associated with onset of medication-related osteonecrosis of the jaw in patients treated with denosumab

Alexander Wick et al. Clin Oral Investig. 2022 Mar.

Abstract

Objectives: While risk factors of bisphosphonate (BP) associated osteonecrosis of the jaw have been properly analyzed, studies focusing on risk factors associated with denosumab (DNO) are sparse. The purpose of this study was to identify risk factors influencing the onset of medication-related osteonecrosis of the jaw (MRONJ) in patients receiving antiresorptive treatment (ART) with DNO by comparing patients suffering from MRONJ and patients without MRONJ. Multiple variables were evaluated including the impact of a previous BP intake.

Materials and methods: A retrospective single-center cohort study with patients receiving DNO was conducted. One-hundred twenty-eight patients were included and divided into three groups: I (control, n = 40) receiving DNO with absence of MRONJ; group II (Test 1, n = 46), receiving DNO with presence of MRONJ; and group III (Test 2, n = 42) sequentially receiving BP and DNO with presence of MRONJ. Patients' medical history, focusing on the identification of MRONJ risk factors, was collected and evaluated. Parameters were sex, age, smoking habit, alcohol consumption, underlying disease (cancer type, osteoporosis), internal diseases, additional chemo/hormonal therapy, oral inflammation, and trauma.

Results: The following risk factors were identified to increase MRONJ onset significantly in patients treated with DNO: chemo/hormonal therapy (p = 0.02), DNO dosage (p < 0.01), breast cancer (p = 0.03), intake of corticosteroids (p = 0.04), hypertension (p = 0.02), diabetes mellitus (p = 0.04), periodontal disease (p = 0.03), apical ostitis (p = 0.02), and denture use (p = 0.02). A medication switch did not affect MRONJ development (p = 0.86).

Conclusions: Malignant diseases, additional chemotherapy, DNO dosage, and oral inflammations as well as diabetes mellitus and hypertension influence MRONJ onset in patients treated with DNO significantly.

Clinical relevance: Patients receiving ART with DNO featuring aforementioned risk factors have a higher risk of MRONJ onset. These patients need a sound and regular prophylaxis in order to prevent the onset of MRONJ under DNO treatment.

Keywords: Bisphosphonates; Denosumab; MRONJ; Osteonecrosis of the jaw; Risk factors.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient distribution into three groups
Fig. 2
Fig. 2
Mosaic plot: underlying disease vs. presence of MRONJ
Fig. 3
Fig. 3
Mosaic plot: DNO dosage vs. presence of MRONJ
Fig. 4
Fig. 4
Mosaic plot: sex vs. presence of MRONJ
See this image and copyright information in PMC

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