Prevention Of Drug-Induced Osteonecrosis Of The Jaw In Cancer Patients

The occurrence of drug-induced osteonecrosis of the jaw in cancer patients treated using bone-modifying medications (bisphosphonates and denosumab) is a highly relevant research problem studied by dentists, maxillofacial surgeons, and oncologists. Despite the large number of publications, practical approaches to preventing drug-induced osteonecrosis of the jaw remain to be developed, which is confirmed by the increasing prevalence and severity of the clinical course of the disease. In this article, we review the most significant works and position papers published in Russia and abroad over the past 10 years, as well as the authors’ scientific and clinical experience, in order to identify key reasons behind the ineffective prevention of drug-induced osteonecrosis of the jaw in cancer patients and to suggests possible solutions. Questions concerning the legal protection of patients and clinicians in relation to this complication are discussed. Most recent achievements in the field of laboratory diagnostics and risk assessment of drug-induced osteonecrosis of the jaw in cancer patients, including the determination of bone metabolism markers, are presented. The following criteria for the safe use of bisphosphonates and denosumab in cancer patients were identified: dental screening; clinical and laboratory monitoring; individualizing drug dosage, duration and withdrawal regimens; application of an interdisciplinary approach.