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Review
. 2023 Jul 15;24(1):36.
doi: 10.1186/s10195-023-00713-7.

Anti-resorptive therapy in the osteometabolic patient affected by periodontitis. A joint position paper of the Italian Society of Orthopaedics and Traumatology (SIOT) and the Italian Society of Periodontology and Implantology (SIdP)

L Landi  1   2 , P Tranquilli Leali  3   4 , L Barbato  5   6 , A M Carrassi  5   7 , N Discepoli  5   8 , P C M Muti  5   7   9 , G Oteri  5   10 , M Rigoni  3   7 , E Romanini  3   11 , C Ruggiero  3   12 , U Tarantino  3   13 , E Varoni  5   7 , N M Sforza  5   14 , M L Brandi  15   16
Affiliations
Review

Anti-resorptive therapy in the osteometabolic patient affected by periodontitis. A joint position paper of the Italian Society of Orthopaedics and Traumatology (SIOT) and the Italian Society of Periodontology and Implantology (SIdP)

L Landi et al. J Orthop Traumatol. .

Abstract

This joint report from the Italian Society of Orthopaedics and Traumatology (SIOT) and the Italian Society of Periodontology and Implantology (SIdP) aims for a consensus around the scientific rationale and clinical strategy for the management of osteoporotic patients affected by periodontitis who are undergoing anti-resorptive (AR) therapy to manage the risk of the occurrence of a medication-related osteonecrosis of the jaws (MRONJ). Osteoporosis and periodontitis are chronic diseases with a high prevalence in aging patients, and they share some of the same pathogenetic mechanisms based upon inflammation. Available evidence shows the relationship among osteoporosis, AR agents, periodontitis and implant therapy in relation to the incidence of MRONJ. Uncontrolled periodontitis may lead to tooth loss and to the need to replace teeth with dental implants. Tooth extraction and surgical dental procedures are recognized as the main risk factors for developing MRONJ in individuals taking AR therapy for osteometabolic conditions. Although the incidence of MRONJ in osteometabolic patients taking AR therapy may be as low as 0.9%, the increasing prevalence of osteoporosis and the high prevalence of periodontitis suggest that this potential complication should not be overlooked. Good clinical practice (GCP) guidelines are proposed that aim at a more integrated approach (prescriber, dentist, periodontist and dental hygienist) in the management of periodontitis patients undergoing AR therapy for osteometabolic disorders to reduce the risk of MRONJ. Dental professional and prescribers should educate patients regarding the potential risk associated with the long-term use of AR therapy and oral health behavior.

Keywords: Anti-resorptive therapy; MRONJ; Osteoporosis; Periimplantitis; Periodontitis.

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Conflict of interest statement

L. Landi: Nothing to disclose. P. Tranquilli Leali: Nothing to disclose. L. Barbato: Nothing to disclose. A.M. Carrassi: Nothing to disclose. N. Discepoli: Nothing to disclose. P.C.M. Muti: Nothing to disclose. G. Oteri: Nothing to disclose. M. Rigoni: Nothing to disclose. E. Romanini: Nothing to disclose. C. Ruggiero: Nothing to disclose. U. Tarantino: Nothing to disclose. E. Varoni: Nothing to disclose. N.M. Sforza: Nothing to disclose. M.L. Brandi: Honoraria: Amgen, Bruno Farmaceutici, Calcilytix, Kyowa Kirin, UCB; grants and/or speaker: Abiogen, Alexion, Amgen, Amolyt, Amorphical, Bruno Farmaceutici, CoGeDi, Echolight, Eli Lilly, Enterabio, Gedeon Richter, Italfarmaco, Kyowa Kirin, Menarini, Monte Rosa, SPA, Takeda, Theramex, UCB; consultant: Aboca, Alexion, Amolyt, Bruno Farmaceutici, Calcilytix, Echolight, Kyowa Kirin, Personal Genomics, UCB.

Figures

Fig. 1
Fig. 1
Proposed algorithms for patients who are about to start AR therapy for osteometabolic disorders
Fig. 2
Fig. 2
Proposed algorithms for patients who are in treatment with bisphosphonates
Fig. 3
Fig. 3
Proposed algorithms for patients who are in treatment with denosumab
See this image and copyright information in PMC

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