MRONJ in patients treated with bisphosphonates or other agents: a 5-year retrospective study
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1
Polytechnical University of Marche, Department of Clinical Specialistic and Dental Sciences, Italy
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2
University of Foggia, Department of Clinical and Experimental Medicine, Italy
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3
Azienda Ospedaliero Universitaria Ospedali Riuniti, Special and Surgical Stomatology Department, Italy
Aim. Medication related osteonecrosis of the jaw (MRONJ) is a potential adverse effect related to the use of several drugs. This pathology is trigged by a continuity solution of the mucosa, such as a dental extraction, and is characterized by the progressive bone destruction in the maxillofacial region. MRONJ pathophysiology is not completely elucidated, and several hypotheses could explain its unique localization to the jaws: inflammation and infection, bone remodeling suppression, and compromised angiogenesis. The presence of all the following characteristics may suggest the presence of MRONJ: current or previous treatment with antiresorptive or biological agents; exposed bone or bone that can be probed through a fistula in the maxillofacial region that persists for more than 8 weeks; no history of head and neck radiotherapy or metastatic disease to the jaws. In this retrospective study we present a single-center experience of a group of patients affected by MRONJ.
Materials and Methods. We report a case series of 53 consecutive patients, from 2013 to 2017, affected by MRONJ, allocated in three groups based on previous/current administered therapy: group A (bisphosphonate), group B (denosumab with or without other bisphosphonates), and group C (other drugs). All patients were treated against osteoclast-mediated bone loss due to bone metastases or osteoporosis. Age, sex, type of therapy, systemic and local risk factors were recorded. Treatment depended on the stage of MRONJ, consisting in medical and minimally-invasive surgical procedures. Follow-up consists in regular clinical and radiological evaluation at days 10, 30, and every 2 months up to 1 year, to ascertain the absence of recurrences.
Results. 53 patients with MRONJ were selected (32 in group A, 12 in group B, and 9 in group C). Our results showed a mean patient age of 66.7 ± 12.0 years (range 43 - 86 years). The mean drugs administration time were 65.6 ± 35.8 and 37.5 ± 23.2 months for group A (osteoporotic and oncologic patients, respectively), 19.5 ± 14.0 months for group B, and 14.2 ± 9.9 months for group C. According to MRONJ staging, 29 cases were Stage 1, 16 cases were Stage 2, and 8 Stage 3. The lesions were predominantly located in the mandible (n = 37). The most common predisposing factors were the presence of residual roots and diffuse periodontitis (n = 15 and 15), while the most common systemic risk factor was the long-term use of corticosteroids (n = 14). 11 cases of recurrent MRONJ were observed: 7 cases MRONJ in group A; 3 cases in group B, and 1 case in group C. No statistical differences were observed between oncological or osteoporotic patients (P > 0.05), nor among the 3 drug groups (P > 0.05).
Discussion. Local risk factors management and periodical clinic-radiological follow-up are recommended in patients at risk for MRONJ and to prevent MRONJ recurrences.
Keywords:
OsteoNecrosis of the Jaw (BRONJ),
MRONJ,
Bisphonates,
osteoporosisi,
bone metastasis
Conference:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018.
Presentation Type:
Poster Presentation
Topic:
Medications-related osteonecrosis of the Jaws
Citation:
Mazzoni
F,
Arena
C,
Testa
N,
Zavaglia
V,
Nori
A and
Santarelli
A
(2019). MRONJ in patients treated with bisphosphonates or other agents: a 5-year retrospective study.
Front. Physiol.
Conference Abstract:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine..
doi: 10.3389/conf.fphys.2019.27.00029
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Received:
24 Oct 2018;
Published Online:
09 Dec 2019.
*
Correspondence:
Mr. Federico Mazzoni, Polytechnical University of Marche, Department of Clinical Specialistic and Dental Sciences, Ancona, Italy, fedemurkez@gmail.com