Preliminary analysis of incidence, risk factors, and management of medication-related osteonecrosis of the jaw in cancer patients

Abstract

Background

Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive and antiangiogenic therapies commonly used to manage bone metastasis and improve bone density in cancer patients. This study aimed to investigate MRONJ's incidence, risk factors, and outcomes of MRONJ in patients receiving these therapies.

Methods

A retrospective cohort study was conducted involving 98 patients who had received antiresorptive or antiangiogenic medications for at least one year. Data were collected from the electronic health records, focusing on demographics, medication details, comorbidities, dental history, and MRONJ status. Logistic regression analysis was used to identify predictors of MRONJ, and Kaplan-Meier survival analysis was used to assess treatment outcomes, comparing surgical and conservative management approaches.

Results

The incidence of MRONJ was 21.4 % among the study cohort. Logistic regression identified prolonged medication duration (odds ratio [OR] = 2.5; p = 0.01), comorbidities (OR = 3.2; p = 0.003), and prior dental procedures (OR = 2.1; p = 0.02) as significant predictors of MRONJ. Kaplan-Meier analysis showed that surgical intervention resulted in longer survival (median 24.5 Â months) than conservative management (median 12.8 months; p < 0.01). Despite the high rates of healing (71.4 %) and pain management success (85.7 %), a recurrence rate of 23.8 % indicated MRONJ's chronic nature of MRONJ.

Conclusion

This study underscores the importance of early identification and interdisciplinary management of MRONJ risk factors, particularly in patients with prolonged antiresorptive or antiangiogenic therapy. Surgical intervention appears beneficial; however, high recurrence rates emphasize the need for vigilant monitoring and patient-specific treatment strategies.