Osteonecrosis of the Jaw Associated with Antiresorptive Pharmacotherapy in Oncological Patients
Antiresorptive pharmacotherapy in the form of bisphosphonates and denosumab is associated, according to current knowledge, with the risk of jaw osteonecrosis, especially following dental procedures such as tooth extractions. The aim of the newly published systematic review was therefore to evaluate the incidence of this complication following dental extractions in connection with the administration of antiresorptive medication and to identify risk factors for jaw osteonecrosis in oncological patients.
Introduction
The administration of bisphosphonates and denosumab in high doses in oncological patients is associated with a higher risk of developing jaw osteonecrosis. The etiology of this complication has not yet been fully elucidated. Possible causes of necrosis development include impaired bone tissue remodeling or infection, which would explain why this complication is more common in patients with periodontitis.
Similarly, the incidence of this complication has not yet been fully elucidated. According to available studies, it usually ranges in single-digit percentages, with some works observing a higher incidence with bisphosphonates and others with denosumab.
Systematic Review
A total of 7 clinical studies met the inclusion criteria for the systematic review. Due to the high heterogeneity of the studies, it was not possible to perform a meta-analysis from the available data, so only a qualitative analysis was performed. All studies were observational, and 4 also had a control group. A total of 550 patients on bisphosphonates and denosumab were included in these clinical studies, with a total of 271 tooth extractions performed after the initiation of antiresorptive therapy.
Findings
The incidence of jaw osteonecrosis ranged from 11–50%, with all cases occurring within 3 years of tooth extraction. In the control group, which received antiresorptive medication but did not undergo tooth extraction, the incidence of jaw osteonecrosis was 3.4–9.3%. In 1 study, the population without antiresorptive medication was also evaluated, with the prevalence of jaw osteonecrosis after tooth extraction being 0.03% in this group.
The influence of age and sex on the risk of jaw osteonecrosis after tooth extraction was evaluated in all analyzed studies. Only in 1 study was a higher risk observed for females, and no statistically significant age difference was found in any study. Statistically significant influence on the risk was not observed in the case of preoperative antibiotic use, alcohol consumption (addressed only in 1 study), tobacco use, presence of diabetes mellitus, type of oncological disease, or concurrent chemotherapy.
According to 1 study, osteonecrosis was more frequent when additive osteotomy was required on the mandible (33 vs. 7.3%), and 1 study observed a higher risk for tooth root amputation. All studies that evaluated the influence of infection on the risk of jaw osteonecrosis agreed that signs of infection before tooth extraction increase the risk of jaw osteonecrosis. In some studies, this risk was observed even with dental hygiene procedures.
Conclusion
The results of the systematic review of 7 clinical studies indicated that the incidence of jaw osteonecrosis after tooth extraction in oncological patients on high doses of bisphosphonates or denosumab ranges widely. In identifying risk factors, the study indicated that a higher risk of jaw osteonecrosis is associated with concomitant jaw osteotomy during extraction or the presence of infection signs before extraction.
(holi)
Source: Schwech N., Nilsson J., Gabre P. Incidence and risk factors for medication-related osteonecrosis after tooth extraction in cancer patients – a systematic review. Clin Exp Dent Res 2023; 9 (1): 55–65, doi: 10.1002/cre2.698.
Did you like this article? Would you like to comment on it? Write to us. We are interested in your opinion. We will not publish it, but we will gladly answer you.
