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Clinical risk factors for severity and prognosis of antiresorptive agent-related osteonecrosis of the jaw: a retrospective observational study

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Abstract

Introduction

The incidence of antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is rare, and its management has not yet been established. This study aimed to investigate the predictors for advanced stage and healing of ARONJ to establish an appropriate treatment strategy.

Materials and methods

We retrospectively analyzed patients diagnosed with ARONJ at Kobe City Medical Center General Hospital between April 2014 and March 2020. Outcomes were defined as stage ≥ 2 ARONJ (primary) and healing of ARONJ (secondary). Multivariate logistic regression analysis was used to detect factors associated with the outcomes, and odds ratios (OR) and 95% confidence intervals (CI) were calculated.

Results

This study included 143 patients (stage ≥ 2 ARONJ, 51%; healing of ARONJ, 60%). Multivariate logistic regression analysis revealed that advanced age (per year) (OR 1.037; 95% CI 1.003–1.072; p = 0.028) and serum albumin (per g/dL) (OR 0.430; 95% CI 0.213–0.869; p = 0.018) were significantly associated with stage ≥ 2 ARONJ. Furthermore, multivariate logistic regression analysis revealed that cancer (yes) (OR 0.099; 95% CI 0.029–0.339; p < 0.001), conservative surgical treatment (yes) (OR 15.42; 95% CI 5.657–42.0; p < 0.001), C-reactive protein (per mg/dL) (OR 0.599; 95% CI 0.415–0.864; p < 0.001), and vitamin D analog (yes) (OR 0.167; 95% CI 0.034–0.827; p = 0.028) were factors associated with healing.

Conclusion

Our findings suggest that age and hypoalbuminemia are associated with the severity of ARONJ, and cancer, high inflammation, and vitamin D analog may impair healing. In contrast, conservative surgical treatment can overcome the poor treatment outcomes associated with ARONJ.

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Acknowledgements

The corresponding author had full access to all data in the study and was responsible for the decision to submit it for publication. The authors thank all the patients who participated in this cohort study. We would like to thank Editage (www.editage.com) for the English language editing.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan

    Masanori Nashi & Toshihiko Takenobu

  2. Department of Pharmacy, Faculty of Medicine, Mie University Hospital, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Toshinori Hirai & Takuya Iwamoto

Authors
  1. Masanori Nashi
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  2. Toshinori Hirai
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  3. Takuya Iwamoto
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  4. Toshihiko Takenobu
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Contributions

MN: contributed to the study design and data collection. TH and TI: contributed to the statistical analysis, creation of figures and tables, evaluation of drug interactions, and proofreading of the entire manuscript. MN and TT: contributed to the writing of the manuscript. All authors were involved in the data interpretation, review, and approval of the final version of the manuscript.

Corresponding author

Correspondence to Masanori Nashi.

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Conflict of interest

All authors have no conflicts of interest.

Ethical approval

This study was approved by Kobe City Medical Center General Hospital (ethics committee number: zn210823). All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Nashi, M., Hirai, T., Iwamoto, T. et al. Clinical risk factors for severity and prognosis of antiresorptive agent-related osteonecrosis of the jaw: a retrospective observational study. J Bone Miner Metab 40, 1014–1020 (2022). https://doi.org/10.1007/s00774-022-01367-x

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