The role of antiresorptive drugs and medication-related osteonecrosis of the jaw in nononcologic immunosuppressed patients: A systematic review

The role of infection in the etiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is poorly understood. Large-scale epidemiological descriptions of the histology and microbiology of BRONJ are not found in the literature. Herein, we present a systematic review of BRONJ histology and microbiology (including demographics, immunocompromised associations, clinical signs and symptoms, disease severity, antibiotic and surgical treatments, and recovery status) validating that infection should still be considered a prime component in the multifactorial disease.

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Medication-Related Osteonecrosis of the Jaw (MRONJ): Are Antiresorptive Drugs the Main Culprits or Only Accomplices? The Triggering Role of Vitamin D Deficiency

Nutrients ◽

10.3390/nu13020561 ◽

2021 ◽

Vol 13 (2) ◽

pp. 561

Author(s):

Luca Dalle Carbonare ◽

Monica Mottes ◽

Maria Teresa Valenti

Keyword(s):

Vitamin D ◽

Clinical Condition ◽

Case Series ◽

Osteonecrosis Of The Jaw ◽

First Case ◽

Vitamin D Levels ◽

Exposed Bone ◽

Antiresorptive Drugs ◽

Almost All

Osteonecrosis of the jaw (ONJ) is a severe clinical condition characterized mostly but not exclusively by an area of exposed bone in the mandible and/or maxilla that typically does not heal over a period of 6–8 weeks. The diagnosis is first of all clinical, but an imaging feedback such as Magnetic Resonance is essential to confirm clinical suspicions. In the last few decades, medication-related osteonecrosis of the jaw (MRONJ) has been widely discussed. From the first case reported in 2003, many case series and reviews have appeared in the scientific literature. Almost all papers concerning this topic conclude that bisphosphonates (BPs) can induce this severe clinical condition, particularly in cancer patients. Nevertheless, the exact mechanism by which amino-BPs would be responsible for ONJ is still debatable. Recent findings suggest a possible alternative explanation for BPs role in this pattern. In the present work we discuss how a condition of osteomalacia and low vitamin D levels might be determinant factors.

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The risk of osteonecrosis of the jaw (ONJ) and adverse outcomes in patients using antiresorptive drugs undergoing orthodontic treatment, A protocol for a systematic review

10.37766/inplasy2020.7.0124 ◽

2020 ◽

Author(s):

Julian Woolley ◽

Oladapo Akintola ◽

Julian Yates ◽

Monica Calasans-Maia ◽

Jose Calasans-Maia ◽

...

Keyword(s):

Systematic Review ◽

Orthodontic Treatment ◽

Osteonecrosis Of The Jaw ◽

Adverse Outcomes ◽

Antiresorptive Drugs

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The risk of osteonecrosis of the jaw and adverse outcomes in patients using antiresorptive drugs undergoing orthodontic treatment: A systematic review

Heliyon ◽

10.1016/j.heliyon.2021.e05914 ◽

2021 ◽

Vol 7 (1) ◽

pp. e05914

Author(s):

Julian Woolley ◽

Oladapo Akintola ◽

Julian Yates ◽

Monica Diuana Calasans-Maia ◽

Jose de Albuquerque Calasans-Maia ◽

...

Keyword(s):

Systematic Review ◽

Orthodontic Treatment ◽

Osteonecrosis Of The Jaw ◽

Adverse Outcomes ◽

Antiresorptive Drugs

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Success rate and safety of dental implantology in patients treated with antiresorptive medication: A systematic review

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00088 ◽

2020 ◽

Author(s):

Ioannis Papadakis ◽

Alexandra Spanou ◽

Demos Kalyvas

Keyword(s):

Systematic Review ◽

Dental Implant ◽

Late Complication ◽

Survival Rates ◽

Osteonecrosis Of The Jaw ◽

Inclusion Criteria ◽

Implant Placement ◽

Antiresorptive Agents ◽

Antiresorptive Drugs

There is no agreement of data in the subject of implant failure and the development of osteonecrosis in patients receiving antiresorptive agents. The purpose of this systematic review is to evaluate whether dental implants placed in patients on antiresorptive medication have an increased failure rate and whether the implant placement or the implant existence are risk factors for developing medication-related osteonecrosis of the jaw (MRONJ). An electronic search was conducted in PubMed/Medline and all publications fulfilling the inclusion criteria were included. The search was completed by a hand research of the references cited in all electronic identified publications and resulted in 411 articles. According to the inclusion criteria, 32 studies were included with a total of 5221 patients, 12 751 implants, 618 cases of implants loss and 136 cases of MRONJ analyzed. It cannot be established that antiresorptive medication affects the dental implant survival rates, because of small number of studies, most of them characterized by a low level of quality. The risk of MRONJ as an early or late complication is also not well established. Therefore, successful dental implant procedures on patients receiving antiresorptive medication might be possible, but more studies need to be carried out in the future to verify this topic. Apart from intravenous antiresorptive drugs, which remain an absolute contraindication, dental implantology in patients under antiresorptive medication is not a contraindication but it must be accompanied with a careful treatment planning, patients must be informed about the possible complications and large follow up periods are essential.

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Prevalence of medication related osteonecrosis of the jaw in patients treated with sequential antiresorptive drugs: systematic review and meta-analysis

Supportive Care in Cancer ◽

10.1007/s00520-020-05882-3 ◽

2020 ◽

Author(s):

Akanksha Srivastava ◽

Graciela M. Nogueras Gonzalez ◽

Yimin Geng ◽

Alexander M. Won ◽

Maria E. Cabanillas ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Osteonecrosis Of The Jaw ◽

Antiresorptive Drugs

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Possible Role of Oral Ibandronate Administration in Osteonecrosis of the Jaw: A Case Report

International Journal of Immunopathology and Pharmacology ◽

10.1177/039463201202500138 ◽

2012 ◽

Vol 25 (1) ◽

pp. 311-316 ◽

Cited By ~ 2

Author(s):

A. Notarnicola ◽

S. Lisi ◽

M. Sisto ◽

A.V. De Marino ◽

M. D'Amore

Keyword(s):

Risk Factors ◽

Osteonecrosis Of The Jaw ◽

Bisphosphonate Therapy ◽

Caucasian Woman ◽

Oral Bisphosphonate ◽

Antiresorptive Drugs ◽

Magnetic Resonance Imaging Mri ◽

Alternative Medications

We describe a case of Osteonecrosis of the Jaw (ONJ) that developed in a 65-year-old Caucasian woman with osteopenia and other risk factors who was receiving low doses of oral bisphosphonate therapy (ibandronate, 150 mg monthly). Computed tomography (CT), panoramic radiographs (OPT), 99mTc-Sn-MDP scintigraphy, and magnetic resonance imaging (MRI) were performed to study the diseased area; cytological examination also revealed the presence of suppurative material around the area of exposed bone. A diagnosis of bisphosphonate-related osteonecrosis of the jaw complicated by osteomyelitis was made. The patient was prescribed a drug protocol consisting of metronidazole 250 mg 2 times daily, chlorhexidine mouthwashes 3 times daily and chewing exercises for two months. Ibandronate was stopped and replaced with strontium ranelate. The symptoms improved and the patient is still under close follow-up. Assessment of the benefits versus risks is particularly necessary in patients with several risk factors to ascertain their eligibility for treatment with antiresorptive drugs and when this is not possible to choose alternative medications.

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