Epidemiology of Medication-Related Osteonecrosis of the Jaw

Author
Type of study
Number
Diagnosis
BRONJ prevalence
Precipitating factor
Boonyapakorn et al. [30]
Prospective
80
Cancer
3.1 %
77 % after tooth extractions
23 % spontaneous
Vahtsevanos et al. [31]
Retrospective
1621
Cancer
8.5 % of MM
 
3.1 % of BCA
 
4.9 % of PCA
 
Bamias et al. [32]
Prospective
252
Cancer
9.9 % of MM
Almost all after dental procedures or dentures
2.9 % of BCA
 
6.5 % of PCA
 
Dimopoulos et al. [33]
Prospective
202
MM
7.4 %
 
Wang et al. [34]
Retrospective
447
Cancer
3.8 % of MM
 
2.5 % of BCA
 
2.9 % of PCA
 
Hoff et al. [35]
Retrospective
1888
Cancer
2.4 % of MM
 
1.2 % of BCA
 
Thumbigere-Math et al. [36]
Retrospective
576
Cancer
7.2 % of MM
59 % s/p tooth extraction
4.2 % of BCA
41 % spontaneous
2.4 % of PCA
 
Assaf et al. [37]
Retrospective
169
Cancer
8.9 %
 
Rugani et al. [38]
Retrospective
63
BCA
10.4 %
 
Walter et al. [39]
Prospective
43
PCA
18.6 %
All patients after tooth extractions or denture pressure sore
Walter et al. [40]
Retrospective
75
BCA
5.3 %
50 % after tooth extraction
MM multiple myeloma, BCA breast cancer, PCA prostate cancer

Osteonecrosis of the Jaw and New Antiresorptive Drugs (Denosumab)

There have been recent reports of osteonecrosis of the jaws developing after exposure to drugs other than BPs [41, 42]. The most alarming results were associated with denosumab, which is a fully human monoclonal antibody that inhibits the maturation of osteoclasts. The first reports of osteonecrosis developing after exposure to denosumab appeared in 2010 [43, 44], with the most extensive study having been prospectively conducted on 5,723 cancer patients [45]. Those patients were randomly assigned to receive either denosumab or zoledronic acid. Oral adverse events were determined by an independent blinded committee of dental experts. The overall incidence of osteonecrosis was 1.6 % (89 patients), most of whom (52 vs. 37) developed under denosumab. Again, as expected, tooth extraction was reported in 61.8 % of the affected patients [45]. The conclusion that can be drawn from the comparative studies listed in Table 5.2 is that osteonecrosis related to the administration of denosumab might be similar or even more prevalent than with intravenous BPs and that comparable or even higher incidence rates of MRONJ development after exposure to denosumab might be expected.

Table 5.2

Epidemiology of osteonecrosis in cancer patients treated with denosumab
Author
Year
Drug
Osteonecrosis (n patients)
Stopeck et al. [46]
2010
Zoledronic acid vs. denosumab
14/1013 vs. 20/1020
Fizazi et al. [47]
2011
Zoledronic acid vs. denosumab
12/945 vs. 22/943
Henry et al. [48]
2011
Zoledronic acid vs. denosumab
11/878 vs. 10/878
Smith et al. [49]
2012
Denosumab
33/716
Papapoulos et al. [50]
2012
Denosumab
2/2206
Lipton et al. [51]
2012
Zoledronic acid vs. denosumab
37/2836 vs. 52/2841

Conclusion

The prevalence of BRONJ is higher after intravenous BPs compared to oral BPs, and even higher among the latter after oral surgical procedures and local infections. This should also be borne in mind in the development of new drugs that carry the risk of medication-related osteonecrosis of the jaw (MRONJ).
References
1.
Kanis JA, Gertz BJ, Singer F, et al. Rationale for the use of alendronate in osteoporosis. Osteoporos Int. 1995;5:1–13.PubMedCrossRef
2.
Glover D, Lipton A, Keller A, et al. Intravenous pamidronate disodium treatment of bone metastases in patients with breast cancer. A dose-seeking study. Cancer. 1994;74:2949–55.PubMedPubMedCrossRef
4.
Rogers MJ, Watts DJ, Russell R. Overview of bisphosphonates. Cancer. 1997;80(8 Suppl):1652–60.PubMedPubMed
6.
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Nov 4, 2015 | Posted by in General Dentistry | Comments Off on Epidemiology of Medication-Related Osteonecrosis of the Jaw
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