Precursor Radiographic Findings in Patients With Medication-Related Osteonecrosis of the Jaw

Ryo Kajihara; Eiji Kondo; Hironobu Fukuda; Hironori Sakai; Takeshi Koike; Hiroshi Kurita

doi:10.1016/j.joms.2024.04.015

Precursor Radiographic Findings in Patients With Medication-Related Osteonecrosis of the Jaw

J Oral Maxillofac Surg. 2024 Apr 26:S0278-2391(24)00275-1. doi: 10.1016/j.joms.2024.04.015. Online ahead of print.

Authors

Ryo Kajihara¹, Eiji Kondo², Hironobu Fukuda³, Hironori Sakai², Takeshi Koike⁴, Hiroshi Kurita⁵

Affiliations

¹ Attending Staff, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan; Attending Staff, Department of Dentistry and Oral Surgery, Ina Central Hospital, Ina, Japan. Electronic address: ryo-kajihara@shinshu-u.ac.jp.
² Assistant Professor, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
³ Attending Staff, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
⁴ Department Head, Department of Dentistry and Oral Surgery, Ina Central Hospital, Ina, Japan.
⁵ Professor, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan.

PMID: 38750657
DOI: 10.1016/j.joms.2024.04.015

Abstract

Background: Oral surgical treatment, such as tooth extraction, has been identified as a risk factor for the onset of medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ may already be latent, and its manifestation may be triggered by extraction.

Purpose: The purpose of this study was to examine the association between pre-extraction imaging and MRONJ.

Study design, setting, sample: We performed a multicenter case-control analysis of patients receiving antiresorptive agents (ARAs) who underwent extraction between 2012 and 2016. We enrolled patients who had undergone tooth extraction in the setting of ARA exposure.

Predictor variables: The predictor variables comprised preoperative radiographic findings associated with MRONJ stage 0. These findings included alveolar bone loss, thickening or obscuring of the periodontal ligament, and osteosclerosis involving the alveolar bone. They were coded as present or absent before tooth extraction.

Main outcome variable: The primary outcome variable was MRONJ status coded as present or absent.

Covariates: Sex, age, underlying diseases necessitating the administration of ARA, the type of ARA used, corticosteroid use, extraction region, and wound closure were analyzed.

Analyses: Mann-Whitney U test, χ² test, Fisher's exact test for univariate analysis, and multiple logistic regression analysis were performed. P values < .05 were significant.

Results: The subjects consisted of 26 patients and 110 controls (male: 8/36, female: 18/74). The mean ages of the MRONJ group and the control group were 77.0 ± 11.9 and 63.0 ± 15.8, respectively (P value = .001). The prevalence of osteosclerosis was significantly higher in the MRONJ group than in the control group (14/72, 53.9%/29.3%, P < .01). Multivariate analysis identified osteosclerosis (odds ratio: 8.4, 95% confidence interval: 2.133.9, P < .01) as a significant independent predictor associated with the development of MRONJ after extraction.

Conclusion and relevance: These findings suggest that a precursor to MRONJ is highly likely to be present in patients with osteosclerosis at the time of extraction. The majority of patients who developed MRONJ after extraction had imaging findings that suggested infection in the surrounding alveolar bone.