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Multicenter Study
. 2025 Jan 10;43(2):180-188.
doi: 10.1200/JCO.24.00171. Epub 2024 Aug 20.

Incidence of Medication-Related Osteonecrosis of the Jaw in Patients With Breast Cancer During a 20-Year Follow-Up: A Population-Based Multicenter Retrospective Study

Christine Brunner  1 , Marjan Arvandi  2 , Christian Marth  1 , Daniel Egle  1 , Florentina Baumgart  1 , Miriam Emmelheinz  1 , Benjamin Walch  3 , Johanna Lercher  3 , Claudia Iannetti  4 , Ewald Wöll  5 , Agnes Pechlaner  5 , August Zabernigg  6 , Birgit Volgger  7 , Maria Castellan  7 , Oliver Tibor Andraschofsky  8 , Alice Markl  9 , Michael Hubalek  10 , Michael Schnallinger  11 , Sibylle Puntscher  2 , Uwe Siebert  2   12   13 , Sebastian Schönherr  14 , Lukas Forer  14 , Emanuel Bruckmoser  15 , Johannes Laimer  3
Affiliations
Multicenter Study

Incidence of Medication-Related Osteonecrosis of the Jaw in Patients With Breast Cancer During a 20-Year Follow-Up: A Population-Based Multicenter Retrospective Study

Christine Brunner et al. J Clin Oncol. .

Abstract

Purpose: Medication-related osteonecrosis of the jaw (MRONJ) is one of the most important toxicities of antiresorptive therapy, which is standard practice for patients with breast cancer and bone metastases. However, the population-based incidence of MRONJ is not well established. We therefore performed a retrospective multicenter study to assess the incidence for a whole Austrian federal state (Tyrol).

Materials and methods: This retrospective multicenter study was conducted between 2000 and 2020 at all nine breast centers across Tyrol, Austria. Using the cancer registry, the total Tyrolean population was screened for all patients with breast cancer. All patients with breast cancer and bone metastases receiving antiresorptive therapy were finally included in the study.

Results: From 8,860 patients initially screened, 639 individuals were eligible and included in our study. Patients received antiresorptive therapy once per month without de-escalation of therapy. MRONJ was diagnosed in 56 (8.8%, 95% CI, 6.6 to 11.0) patients. The incidence of MRONJ was 11.6% (95% CI, 8.0 to 15.3) in individuals treated with denosumab only, 2.8% (95% CI, 0.7 to 4.8) in those treated with bisphosphonates only, and 16.3% (95% CI, 8.8 to 23.9) in the group receiving bisphosphonates followed by denosumab. Individuals developed MRONJ significantly earlier when treated with denosumab. Time to MRONJ after treatment initiation was 4.6 years for individuals treated with denosumab only, 5.1 years for individuals treated with bisphosphonates only, and 8.4 years for individuals treated with both consecutively.

Conclusion: MRONJ incidence in breast cancer patients with bone metastases was found to be considerably higher, especially for patients receiving denosumab, when compared with available data in the literature. Additionally, patients treated with denosumab developed MRONJ significantly earlier.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Christine Brunner

Employment: Roche

Honoraria: Amgen, Daiichi Sankyo/Astra Zeneca, Roche, Novartis Institutes for BioMedical Research

Consulting or Advisory Role: Roche

Speakers' Bureau: AstraZeneca

Travel, Accommodations, Expenses: Daiichi Sankyo/Astra Zeneca, Amgen, Roche

Christian Marth

Honoraria: AstraZeneca, GlaxoSmithKline, MSD

Consulting or Advisory Role: MSD, GlaxoSmithKline, AbbVie

Travel, Accommodations, Expenses: Roche, AstraZeneca

Daniel Egle

Honoraria: AstraZeneca, Gilead Sciences, Daiichi Sankyo Europe GmbH, Pfizer, Roche/Genentech, Novartis, Lilly, Sirius Medical

Consulting or Advisory Role: AstraZeneca, Daiichi Sankyo Europe GmbH, Gilead Sciences, Novartis, Lilly

Research Funding: Sirius Medical (Inst)

Travel, Accommodations, Expenses: Daiichi Sankyo Europe GmbH, Pfizer

Florentina Baumgart

Travel, Accommodations, Expenses: Sandoz

Miriam Emmelheinz

Travel, Accommodations, Expenses: Teva, Sandoz

Claudia Iannetti

Honoraria: Lilly

Ewald Wöll

Consulting or Advisory Role: Amgen Astellas BioPharma

August Zabernigg

Honoraria: Roche, BMS GmbH & Co. KG, AstraZeneca, Takeda, Lilly

Consulting or Advisory Role: Amgen, Takeda

Travel, Accommodations, Expenses: Lilly, OPSI

Birgit Volgger

Consulting or Advisory Role: Novartis, Gilead Sciences, GlaxoSmithKline, Pfizer, AstraZeneca, Eisai, MSD

Travel, Accommodations, Expenses: MSD, Pfizer

Maria Castellan

Honoraria: Roche Novartis, Sanova, Daiichi Sankyo, Seagen, Gilead, Lilly, Pfizer

Consulting or Advisory Role: Novartis, Lilly

Travel, Accommodations, Expenses: Pfizer, Roche, Novartis, Daiichi Sankyo, MSD, Lilly

Michael Schnallinger

Honoraria: Janssen

Consulting or Advisory Role: Novartis, Janssen, Amgen, Takeda

Travel, Accommodations, Expenses: Roche, Novartis

Lukas Forer

Honoraria: Novartis

No other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
CONSORT diagram. MRONJ, medication-related osteonecrosis of the jaw.
FIG 2.
FIG 2.
Cumulative incidence of MRONJ in the different treatment groups over the treatment period. MRONJ, medication-related osteonecrosis of the jaw.
FIG 3.
FIG 3.
Kaplan-Meier curves for overall survival since first diagnosis in the treatment groups (truncated to 12 years).
See this image and copyright information in PMC

References

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