J Korean Assoc Oral Maxillofac Surg.  2019 Apr;45(2):108-115. 10.5125/jkaoms.2019.45.2.108.

Risk factors of medication-related osteonecrosis of the jaw: a retrospective study in a Turkish subpopulation

• Åžahin O
• Odabaşı
• Aliyev T
• Tatar B

• KMID: 2467154
• DOI: http://doi.org/10.5125/jkaoms.2019.45.2.108

Abstract

OBJECTIVES
Medication-related osteonecrosis of the jaw (MRONJ) is a well-known side effect of certain drugs that are used to influence bone metabolism to treat osteometabolic disease or cancers. The purpose of our study was to investigate how high-concentration and low-concentration bisphosphonate (BP) intake affects the disease severity.
MATERIALS AND METHODS
Data collected from the medical records of 52 patients treated with BPs, antiresorptive, antiangiogenic drugs and diagnosed with MRONJ were included in this study. Age, sex, type of systemic disease, type of drug, duration of drug treatment, jaw area with MRONJ, drug administration protocol, and MRONJ clinical and radiological findings were obtained. Patients were divided into two groups: anti-neoplastic (Group I, n=23) and anti-osteoporotic (Group II, n=29). Statistical evaluations were performed using the IBM SPSS ver. 21.0 program.
RESULTS
In both groups, more females had MRONJ. MRONJ was found in the mandibles of 30 patients (Group I, n=14; Group II, n=16). When we classified patients according to the American Association of Oral and Maxillofacial Surgeons staging system, significant differences were seen between groups (χ2=12.23, P<0.01). More patients with advanced stage (stage 2-3) MRONJ were found in Group I (60.9%).
CONCLUSION
According to our results, high-concentration BP intake, age and duration of drug intake increased disease severity.

Keyword

Bisphosphonate-associated osteonecrosis of the jaw; Osteonecrosis; Risk factors; Zoledronic acid

MeSH Terms

Bisphosphonate-Associated Osteonecrosis of the Jaw
Female
Humans
Jaw*
Mandible
Medical Records
Metabolism
Oral and Maxillofacial Surgeons
Osteonecrosis*
Retrospective Studies*
Risk Factors*

Figure

• 

  Fig. 1 Clinical findings of some medication-related osteonecrosis of the jaw (MRONJ) patients in this study. A. MRONJ lesion developed that following tooth extraction at right mandibular premolar area. B. Clinical image of maxillary exposed, necrotic bone in a MRONJ patient due to prosthesis trauma. C. Stage II MRONJ in a female patient treated with alendronate for osteoporosis. D. Extra-oral draining fistula at the submandibular region of the jaw in a patient with stage 3 MRONJ.

• 

  Fig. 2 Radiological findings of some medication-related osteonecrosis of the jaw (MRONJ) patients in this study. A. Panoramic radiograph demonstrating a pathologic fracture of the left molar region of the mandible in a patient with metastatic breast and stage 3 MRONJ. B. Panoramic radiography demonstrated osteolytic process at the left mandible. C. Panoramic radiography showing persisting alveolar socket in the mandible. D. Panoramic radiography demonstrated diffuse osteolysis of the jaw with areas of bone sclerosis.

• 

  Fig. 3 Clinical and radiologic findings after dental implant treatment in medication-related osteonecrosis of the jaw (MRONJ) patients using zoledronate and denosumab. A. Clinical view after dental implant treatment in MRONJ patient using denosumab. B. Panoramic radiography showed sequestrum line around of the dental implant at the right mandible molar area.

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