The Type of Antiresorptive Treatment Influences the Time to Onset and the Surgical Outcome of Medication-Related Osteonecrosis of the Jaw

Christoph Pautke; Alexander Wick; Sven Otto; Bettina Hohlweg-Majert; Jürgen Hoffmann; Oliver Ristow

doi:10.1016/j.joms.2020.10.005

The Type of Antiresorptive Treatment Influences the Time to Onset and the Surgical Outcome of Medication-Related Osteonecrosis of the Jaw

J Oral Maxillofac Surg. 2021 Mar;79(3):611-621. doi: 10.1016/j.joms.2020.10.005. Epub 2020 Oct 13.

Authors

Christoph Pautke¹, Alexander Wick², Sven Otto³, Bettina Hohlweg-Majert⁴, Jürgen Hoffmann⁵, Oliver Ristow⁶

Affiliations

¹ Professor, Private Practitioner, Ludwig-Maximilians University Munich, Department of Oral and Maxillofacial Surgery Medizin & Aesthetik, Clinic for Oral and Maxillofacial and Plastic Surgery, Munich, Germany. Electronic address: christoph.pautke@gmx.net.
² Resident, Medizin & Aesthetik, Clinic for Oral and Maxillofacial and Plastic Surgery, Munich, Germany.
³ Professor, Despartment of Oral and Maxillofacial Surgery, University of Halle, Halle, Germany.
⁴ Professor, Private Practitioner, Medizin & Aesthetik, Clinic for Oral and Maxillofacial and Plastic Surgery, Munich, Germany.
⁵ Professor, Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany.
⁶ Consultant, Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany.

PMID: 33166522
DOI: 10.1016/j.joms.2020.10.005

Abstract

Purpose: Few data exist focusing on differences in the time to disease onset and the success rates in patients suffering from medication-related osteonecrosis of the jaw (MRONJ) dependent on their different antiresorptive treatment. The purpose of this study was to analyze and compare these variables for patients treated with bisphosphonate (BP) or denosumab (DNO) and for patients who switched the antiresorptive drug (BP/DNO).

Patients and methodss: A retrospective single-center cohort study with patients suffering from MRONJ was conducted. The predictor variable was the antiresorptive treatment, the outcome variables were 1) time to onset of MRONJ (time of antiresorptive treatment to MRONJ diagnosis) and 2) treatment success (mucosal integrity 12 months postoperatively). The other variables include data on demographic, underlying disease, MRONJ stage, and trigger events. Cox and logistic regression, Phi-coefficient, Cramer's V, and Kruskal-Wallis tests were applied.

Results: One hundred thirty-two patients were included and divided into 3 groups: group I (BP) n = 45 patients, n = 59 lesions; group II (BP/DNO) n = 42 patients, n = 71 lesions; and group III (DNO) n = 45 patients, n = 62 MRONJ lesions. Treatment success and time to onset differed significantly between the groups: success rates in group I BP (84.7%) were significantly lower (P = .04) than in group II BP/DNO (91.5%, P = .12) and group III DNO (90.3%, P = .35). The onset was significantly earlier in group III DNO (median 2.0 years, Q_0.25: 1.49, Q_0.75: 2.98; confidence interval 95%: 1.93 to 2.83) than in group II BP/DNO (median 4.07 years, Q_0.25: 1.64, Q_0.75: 6.70; confidence interval 95%: 3.55 to 5.68) and group I BP (median 3.86 years, Q_0.25: 1.69, Q_0.75: 6.46; confidence interval 95%: 3.43 to 5.87).

Conclusions: The different antiresorptive drugs show distinctive characteristics of time to onset and treatment success with the lowest success rates in the BP group and the earliest onset in the DNO group. The switch of the antiresorptive therapy (BP to DNO) did not influence the outcome variables negatively.

MeSH terms

Bisphosphonate-Associated Osteonecrosis of the Jaw* / surgery
Bone Density Conservation Agents* / adverse effects
Cohort Studies
Diphosphonates / adverse effects
Humans
Retrospective Studies
Treatment Outcome

Substances

Bone Density Conservation Agents
Diphosphonates