Prognosis of medication-related osteonecrosis of the jaws in cancer patients using antiresorptive agent zoledronic acid

Ling-Ying Wei; Sang-Heng Kok; Yen-Ching Lee; Wei-Yih Chiu; Jai-Jen Wang; Shih-Jung Cheng; Hao-Hueng Chang; Jang-Jaer Lee

doi:10.1016/j.jfma.2020.11.017

Prognosis of medication-related osteonecrosis of the jaws in cancer patients using antiresorptive agent zoledronic acid

J Formos Med Assoc. 2021 Aug;120(8):1572-1580. doi: 10.1016/j.jfma.2020.11.017. Epub 2020 Dec 11.

Authors

Ling-Ying Wei¹, Sang-Heng Kok², Yen-Ching Lee³, Wei-Yih Chiu⁴, Jai-Jen Wang⁵, Shih-Jung Cheng², Hao-Hueng Chang², Jang-Jaer Lee⁶

Affiliations

¹ Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Bei-hu Branch, Taipei, Taiwan.
² Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Department of Finance, Feng Chia University, Taichung, Taiwan.
⁶ Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: leejj@ntuh.gov.tw.

PMID: 33309430
DOI: 10.1016/j.jfma.2020.11.017

Abstract

Background/purpose: Anti-resorptive agents are commonly used in cancer patients with bone metastasis or multiple myeloma (MM). An adverse event termed medication-related osteonecrosis of the jaws (MRONJ) was discovered in patients using these agents but relatively little attention has been paid to its prognosis. Our aims were to find out the treatment outcomes and prognostic indicators of MRONJ in cancer patients who received zoledronic acid as antiresorptive therapy.

Methods: We retrospectively surveyed a cohort of 133 cancer patients who received zoledronic acid. A total of 150 MRONJ lesions were included for investigation. Cumulative complete response rate after treatment was calculated with the Kaplan-Meier method, and significance was examined with the log-rank tests. Cox regression was used for univariate and multivariate analyses of prognostic factors.

Results: The cumulative complete response rate of all patients at 24 months was 53.2%, and those of patients with MM, breast cancer and prostate cancer were 27.8%, 60.7% and 68.0%, respectively. Having MM was identified as an independent prognostic factor in a multivariate analysis with adjusted hazard ratios of 0.28 (95% confidence interval, 0.09-0.83).

Conclusion: For cancer patients with ONJ related to zoledronic acid, patients with MM endure a worse treatment outcome.

Keywords: Bone metastasis; Cancer; Medication-related osteonecrosis of the jaws (MRONJ); Prognosis; Zoledronic acid.

MeSH terms

Bisphosphonate-Associated Osteonecrosis of the Jaw* / epidemiology
Bone Density Conservation Agents* / adverse effects
Bone Neoplasms* / drug therapy
Diphosphonates / adverse effects
Humans
Jaw
Male
Osteonecrosis*
Prognosis
Retrospective Studies
Zoledronic Acid / adverse effects

Substances

Bone Density Conservation Agents
Diphosphonates
Zoledronic Acid