Diseases of Bone and Cartilage

Jaw Osteonecrosis Linked to Treatment for Bone Metastases

Medication-related osteonecrosis of the jaw (MRONJ) is a rare complication of antiresorptive treatments for osteoporosis. It is characterized as an area of exposed necrotic jawbone that persists >8 weeks in someone with bisphosphonate or denosumab exposure.20 Less than 0.1% of patients with osteoporosis using a bisphosphonate or denosumab develop MRONJ.20 A similar condition has been observed in patients receiving anticancer drugs, glucocorticoids, methotrexate, adalimumab, etanercept, or rituximab.21 The cause of MRONJ is unclear, but may relate to the osteoclastic effects of antiresorptive agents and the antiangiogenic or immunosuppressive effects of other drugs.22 MRONJ in patients with osteoporosis is usually preceded by invasive dental procedures, and antibiotic prophylaxis can reduce risk.20 Periodontal disease, oral infection or trauma, and longer osteoporosis treatment also increase risk.1,20 Limited data suggest patients with RA have a greater risk for MRONJ, possibly because of RA's skeletal effects.1,22 Severe MRONJ may require surgery, whereas early disease is managed conservatively.20

Medication-related osteonecrosis of the jaw (MRONJ) is a rare complication of antiresorptive treatments for osteoporosis. It is characterized as an area of exposed necrotic jawbone that persists >8 weeks in someone with bisphosphonate or denosumab exposure.20 Less than 0.1% of patients with osteoporosis using a bisphosphonate or denosumab develop MRONJ.20 A similar condition has been observed in patients receiving anticancer drugs, glucocorticoids, methotrexate, adalimumab, etanercept, or rituximab.21

The cause of MRONJ is unclear, but may relate to the osteoclastic effects of antiresorptive agents and the antiangiogenic or immunosuppressive effects of other drugs.22 MRONJ in patients with osteoporosis is usually preceded by invasive dental procedures, and antibiotic prophylaxis can reduce risk.20 Periodontal disease, oral infection or trauma, and longer osteoporosis treatment also increase risk.1,20 Limited data suggest patients with RA have a greater risk for MRONJ, possibly because of RA’s skeletal effects.1,22 Severe MRONJ may require surgery, whereas early disease is managed conservatively.20

The cumulative three-year incidence of osteonecrosis of the jaw is 2.8% in cancer patients receiving zoledronic acid for metastatic bone disease.

HealthDay News — The cumulative three-year incidence of osteonecrosis of the jaw (ONJ) is 2.8 percent in cancer patients receiving zoledronic acid for metastatic bone disease (MBD), according to a study published online Dec. 17 in JAMA Oncology.

Catherine H. Van Poznak, M.D., from the University of Michigan in Ann Arbor, and colleagues examined the cumulative incidence of ONJ at three years in patients receiving zoledronic acid for MBD from any malignant neoplasm.

Among 2,263 participants with a baseline dental examination, the researchers found that 90 patients developed confirmed ONJ, with a cumulative incidence of 0.8 percent at year 1, 2.0 percent at year 2, and 2.8 percent at year 3. Among patients with myeloma, the three-year cumulative incidence was highest. ONJ was more likely among patients with planned zoledronic acid dosing intervals of less than five weeks versus those with planned dosing intervals of five weeks or longer (hazard ratio [HR], 4.65). A lower total number of teeth, the presence of dentures (HR, 1.83), and current smoking (HR, 2.12) were associated with a higher rate of ONJ.

“These data provide information to guide stratification of risk for developing ONJ in patients with MBD receiving zoledronic acid,” the authors write.

Abstract/Full Text (subscription or payment may be required)

  • Latest News Your top articles for Sunday

  • Haymarket Medical NetworkTop Picks

  • Loading...

    Continuing Medical Education (CME/CE) Courses

    Show More