Risk Factors Influencing Medication-Related Osteonecrosis of the Jaws (MRONJ) Following Dental Extraction Among Osteoporotic Patients in Taiwan.

IF 2.3 3区医学 Q1 OTORHINOLARYNGOLOGY Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2024-11-29 DOI:10.1002/hed.28011

Ling-Ying Wei, Yi-Wen Cheng, Wei-Yih Chiu, Sang-Heng Kok, Hao-Hong Chang, Shih-Jung Cheng, Jang-Jaer Lee

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Abstract

Aim: Antiresorptive therapy (ART) is commonly used in osteoporotic patients to prevent bone loss. This retrospective cohort study aimed to identify the risk factors associated with medication-related osteonecrosis of the jaw (MRONJ) in osteoporotic patients receiving dental extraction during ART.

Materials and methods: Data were collected from 937 patients with 1067 dental extractions conducted between January 2003 and May 2022, including 519 patients on oral alendronate, 276 on denosumab, and 172 on zoledronate. Multivariate logistic regression analysis was employed to assess potential risk factors.

Results: Regression model analysis revealed older age (AOR 1.09 per year; 95% CI, 1.06-1.12) and drug treatment exceeding 24 months (AOR 2.07; 95% CI, 1.29-3.30) as significant risk factors. A drug interruption of 3 or more months prior to tooth extraction lowered MRONJ risk (AOR 0.11; 95% CI, 0.07-0.17). Stratified by drug type, denosumab users had significantly lower risk of MRONJ after extraction (AOR 0.14; 95% CI, 0.07-0.27) compared to those on other medications. Factors of drug duration ≥ 24 months, < 3 months of interruption, and posterior mandibular tooth extraction posed the highest synergistic MRONJ risk (AOR 80.29; 95% CI, 33.05-195.09).

Conclusion: Our results suggest an association between a three-month ART interruption prior to tooth extraction and reduced MRONJ risk, especially in long-term ART patients undergoing posterior mandibular extractions. However, these findings require validation through prospective randomized controlled trials.

Clinical relevance: Scientific Rationale for Study: The study fills crucial knowledge gaps regarding MRONJ risks in osteoporotic patients undergoing dental extraction during antiresorptive therapy (ART), providing a foundation for informed clinical decisions.

Principal findings: Noteworthy findings include elevated MRONJ risk with older age and prolonged ART, the protective effect of a 3-month ART interruption, and denosumab users showing significantly reduced postextraction MRONJ risk.

Practical implications: Implementing a 3-month ART interruption before dental extraction is recommended to reduce MRONJ occurrences.

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影响台湾骨质疏松患者拔牙后药物相关性颌骨坏死的危险因素。

目的：抗骨吸收治疗（ART）是预防骨质疏松症患者骨质流失的常用方法。本回顾性队列研究旨在确定在ART期间接受拔牙的骨质疏松症患者药物相关性颌骨骨坏死（MRONJ）的相关危险因素。材料与方法：收集2003年1月至2022年5月937例拔牙患者1067例的数据，其中口服阿仑膦酸盐519例，地诺单抗276例，唑来膦酸盐172例。采用多因素logistic回归分析评估潜在危险因素。结果：回归模型分析显示年龄较大(AOR为1.09 /年；95% CI, 1.06-1.12)和药物治疗超过24个月(AOR 2.07；95% CI, 1.29-3.30)为显著危险因素。拔牙前药物中断3个月或更长时间可降低MRONJ风险(AOR 0.11；95% ci, 0.07-0.17)。按药物类型分层，denosumab使用者提取后MRONJ的风险显著降低(AOR 0.14；95% CI, 0.07-0.27)。结论：我们的研究结果表明拔牙前三个月的ART中断与MRONJ风险降低有关，特别是在长期接受后下颌拔牙的ART患者中。然而，这些发现需要通过前瞻性随机对照试验来验证。临床相关性：研究的科学依据：该研究填补了关于骨质疏松症患者在接受抗吸收治疗（ART）期间拔牙时MRONJ风险的关键知识空白，为知情的临床决策提供了基础。主要发现：值得注意的发现包括随着年龄的增长和ART时间的延长，MRONJ风险升高，ART中断3个月的保护作用，denosumab使用者显示提取后MRONJ风险显着降低。实际意义：建议在拔牙前实施3个月的ART中断，以减少MRONJ的发生。

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来源期刊

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.

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