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Medication-related osteonecrosis of the lower jaw without osteolysis on computed tomography images

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Abstract

Introduction

Surgery is the standard treatment for medication-related osteonecrosis of the jaw (MRONJ). This study reviewed patients with mandibular MRONJ who underwent surgical treatment, and in particular the characteristics of non-osteolytic MRONJ with no evidence of osteolysis on CT were described.

Materials and methods

We conducted a retrospective study of patients with mandibular MRONJ who underwent surgery between January 2016 and September 2022. Various clinical and imaging factors regarding treatment outcomes were investigated and analyzed. Additionally, the disease course of non-osteolytic MRONJ was examined in detail.

Results

This study included 55 patients (66 surgeries) with a mean age of 74.7. The primary disease was osteoporosis (24 patients) and malignancy (31 patients); the type of antiresorptive agent was bisphosphonate (BP) in 21 patients and denosumab (DMB) in 26. BP was initially administered; however, it was changed to DMB in eight patients. Preoperatively, the cumulative cure rates for all 66 surgeries were 72.8% at 1 year and 77.3% at 2 years. Cure rates were significantly lower in patients with malignancy, those without osteolysis, and those who underwent sequestrum removal or marginal mandibulectomy than those with osteoporosis, osteolysis, and segmental mandibulectomy. Non-osteolytic MRONJ was observed in eight patients, all with malignancy and receiving high-dose DMB. Only two patients were cured after the initial surgery, and most patients ultimately underwent segmental mandibulectomy.

Conclusions

Surgical treatment yielded good treatment outcomes in most patients with mandibular MRONJ; however, the cure rate was lower in patients with malignancy who showed no osteolysis on CT images.

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Data availability

The datasets used and analyzed in the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank Editage (www.editage.jp) for their English language editing services.

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Authors and Affiliations

  1. Department of Oral Surgery and Oral Care Center, Kansai Medical University Hospital, 2-3-1, Shin-Machi, Hirakata, Osaka, 573-1191, Japan

    Yuka Kojima & Shunsuke Sawada

  2. Department of Oral Surgery, Kansai Medical University Medical Center, Moriguchi, Japan

    Yuki Sakamoto

Authors
  1. Yuka Kojima
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  2. Shunsuke Sawada
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  3. Yuki Sakamoto
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Contributions

Study design: YK. Study conduct: YK. Data collection: YK, SS and YS. Data analysis: YK. YK, SS and YS interpreted the data. YK. drafted the manuscript. Revision of the manuscript content: SS and YS. Approval of the final version of the manuscript: YK, SS and YS. YK takes responsibility for the integrity of data analysis.

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Correspondence to Yuka Kojima.

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Kojima, Y., Sawada, S. & Sakamoto, Y. Medication-related osteonecrosis of the lower jaw without osteolysis on computed tomography images. J Bone Miner Metab 42, 27–36 (2024). https://doi.org/10.1007/s00774-023-01484-1

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  • DOI: https://doi.org/10.1007/s00774-023-01484-1

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