Risk factors of medication-related osteonecrosis of the jaw: A clinical investigation

Yuko Komatsu; Tadashi Kawai; Taifu Hirano; Isao Hoshi; Genki Yamaya; Atsushi Ogawa; Toshimi Chiba; Hiroyuki Yamada

doi:10.1016/j.jormas.2024.101791

Risk factors of medication-related osteonecrosis of the jaw: A clinical investigation

J Stomatol Oral Maxillofac Surg. 2024 Feb 4;125(6):101791. doi: 10.1016/j.jormas.2024.101791. Online ahead of print.

Authors

Yuko Komatsu¹, Tadashi Kawai², Taifu Hirano¹, Isao Hoshi¹, Genki Yamaya¹, Atsushi Ogawa¹, Toshimi Chiba³, Hiroyuki Yamada¹

Affiliations

¹ Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Japan.
² Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Japan. Electronic address: kawait@iwate-med.ac.jp.
³ Division of Internal Medicine, Department of Oral Medicine, School of Dentistry, Iwate Medical University, Japan.

PMID: 38320674
DOI: 10.1016/j.jormas.2024.101791

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is an intractable condition caused by drugs such as bisphosphonates and denosumab. This study investigated the changes in the incidence of MRONJ in the previous 10 years and examined the poor prognostic factors during surgery in at-risk patients. We compared 57 and 64 patients diagnosed with MRONJ at our hospital between January 2012 and December 2016 and January 2017 and December 2021, respectively. The disease stage and triggers at the time of initial diagnosis in eligible patients were investigated. Additionally, the adverse prognostic factors were examined in 166 patients at risk of MRONJ who underwent tooth extraction at our department during these 10 years. The results indicated that there was no change in the proportion of patients with osteoporosis and malignancy among those with MRONJ. The number of cases after tooth extraction decreased, and those after dental infections increased on comparing the recent 5 years and the preceding 5 years. The number of MRONJ patients receiving denosumab also increased. Denosumab was a significant post-extraction prognostic factor for delayed healing in the 166 patients at risk of MRONJ. The findings suggest that patients receiving denosumab should be closely monitored when undergoing surgery to prevent MRONJ.

Keywords: Bisphosphonates; Denosumab; Dental infection; Medication; Osteonecrosis.