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. 2022 May 19;10(5):89.
doi: 10.3390/dj10050089.

Medication-Related Osteonecrosis of the Jaw in Dental Practice: A Retrospective Analysis of Data from the Milan Cohort

Cristina Mirelli  1 , Sonia Marino  1 , Andrea Bovio  1 , Sara Pederielli  1 , Cristina Dall'Agnola  1 , Aldo Bruno Gianni  1   2 , Roberto Biagi  1   2
Affiliations

Medication-Related Osteonecrosis of the Jaw in Dental Practice: A Retrospective Analysis of Data from the Milan Cohort

Cristina Mirelli et al. Dent J (Basel). .

Abstract

A retrospective analysis was performed with the aim of understanding whether the risk factors showed in the literature for medication-related osteonecrosis of the jaws (MRONJ) in cancer patients are also relevant in osteoporotic patients taking antiresorptive drugs (ARDs). Data were retrospectively pooled from health records of patients on ARDs who requested a dental visit between January 2006 and April 2020 in the Dental Unit at Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan. A total of 434 patients were included. The following variables were collected: sex, age, smoking habit, type of ARD, duration of treatment, route of administration, therapeutic indication, concurrent systemic therapies and pathologies. Statistical analysis confirmed the relevance of chemotherapy, smoking, and immunosuppressive drugs as risk factors. In addition, a higher frequency of MRONJ in osteoporotic patients was reported in our cohort in association with an immunodeficiency disorder of variable origin. In conclusion, the identification of individual risk-profile before dental treatments is crucial for prevention. Anamnesis should include main risk factors, such as immunosuppression, dental extractions, smoking, trauma, and poor dental health. Nevertheless, our suggestion for dental professionals is to conduct a complete medical history of patients who mention long-term per oral therapies with ARDs for osteoporosis. Osteoporotic, as well as cancer patients, may also benefit from periodic monitoring of the ARDs therapy in order to prevent MRONJ.

Keywords: Antiresorptive Agent-Related Osteonecrosis of the Jaw (ARONJ); MRONJ; bisphosphonate; denosumab; osteonecrosis; osteoporosis; risk factor.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Workflow of patient selection.
Figure 2
Figure 2
MRONJ incidence by age groups.
Figure 3
Figure 3
Detail of stratification by age.
Figure 4
Figure 4
MRONJ incidence by ARDs taken; Figure refers to the total number of drugs taken.
Figure 5
Figure 5
Pearson residuals express difference from mean (expected) in sigma units. Its clinical meaning is a shortcoming of expected cases in patients treated with clodronate compared to the other ARDs.
Figure 6
Figure 6
Relative incidence of MRONJ in G1, G2, and G3 by route of administration.
Figure 7
Figure 7
A summary of odds ratio log for each class of drugs vs. no drugs.
See this image and copyright information in PMC

References

    1. Marx R.E. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: A growing epidemic. J. Oral Maxillofac. Surg. 2003;61:1115–1117. doi: 10.1016/S0278-2391(03)00720-1. - DOI - PubMed
    1. Marx R.E., Cillo J.E., Ulloa J.J. Oral Bisphosphonate-Induced Osteonecrosis: Risk Factors, Prediction of Risk Using Serum CTX Testing, Prevention, and Treatment. J. Oral Maxillofac. Surg. 2007;65:2397–2410. doi: 10.1016/j.joms.2007.08.003. - DOI - PubMed
    1. Ruggiero S.L., Mehrotra B., Rosenberg T.J., Engroff S.L. Osteonecrosis of the Jaws Associated with the Use of Bisphosphonates: A Review of 63 Cases. J. Oral Maxillofac. Surg. 2004;62:527–534. doi: 10.1016/j.joms.2004.02.004. - DOI - PubMed
    1. Srinivasan D., Shetty S., Ashworth D., Grew N., Millar B. Orofacial pain—A presenting symptom of bisphosphonate associated osteonecrosis of the jaws. Br. Dent. J. 2007;203:91–92. doi: 10.1038/bdj.2007.635. - DOI - PubMed
    1. Ruggiero S.L., Dodson T.B., Fantasia J., Goodday R., Aghaloo T., Mehrotra B., O’Ryan F. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J. Oral Maxillofac. Surg. 2014;72:1938–1956. doi: 10.1016/j.joms.2014.04.031. - DOI - PubMed