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Journal of Bone and Mineral Metabolism

, Volume 35, Issue 1, pp 6–19 | Cite as

Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw

  • Japanese Allied Committee on Osteonecrosis of the Jaw
  • Toshiyuki Yoneda
  • Hiroshi Hagino
  • Toshitsugu Sugimoto
  • Hiroaki Ohta
  • Shunji Takahashi
  • Satoshi Soen
  • Akira Taguchi
  • Toshihiko Nagata
  • Masahiro Urade
  • Takahiko Shibahara
  • Satoru Toyosawa
Perspective

Abstract

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is an intractable, though rare, complication in cancer patients with bone metastases and patients with osteoporosis who are treated with antiresorptive agents, including bisphosphonates and denosumab. Despite the more than 10 years that have passed since the first cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) were reported, our understanding of the epidemiology and pathophysiology of ARONJ remains limited, and data supported by evidence-based medicine are still sparse. However, the diagnosis and staging of ARONJ, identification of risk factors, and development of preventive and therapeutic approaches have advanced significantly over the past decade. The Position Paper 2017 is an updated version of the Position Paper 2010 of the Japanese Allied Committee on Osteonecrosis of the Jaw, which now comprises six Japanese academic societies. The Position Paper 2017 describes a new diagnostic definition for ARONJ, as proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), summarizes our current understanding of the pathophysiology of ARONJ based on a literature search, and suggests methods for physicians and dentists/oral surgeons to manage the disease. In addition, the appropriateness of discontinuing antiresorptive medications (drug holiday) before, during, and after invasive dental treatments is discussed extensively. More importantly, the manuscript also proposes, for the first time, the importance of interactive communication and cooperation between physicians and dentists/oral surgeons for the successful treatment of ARONJ. The Position Paper 2017 is intended to serve as a guide for improving the management of ARONJ patients in Japan.

Keywords

Osteonecrosis of the jaw Bisphosphonates Denosumab Drug holidays Oral bacterial infection Team therapeutic approaches 

Notes

Compliance with ethical standards

Conflict of interest

Toshiyuki Yoneda: consultant fee (Daiichi-Sankyo). Hiroaki Ohta: lecture fee (Pfizer), manuscript fee (Medical Review Co., Ltd.). Toshitsugu Sugimoto: lecture fee, consultant fee (Asahi Kasei Pharma, Pfizer), research grant (Astellas Pharma, Eisai, Ono Pharmaceutical, Daiichi-Sankyo, Chugai Pharmaceutical, Eli Lilly Japan). Satoshi Soen: lecture fee (Asahi Kasei Pharma, Astellas Pharma, Eisai, MSD, Ono Pharmaceutical, Daiichi-Sankyo, Takeda Pharmaceutical, Chugai Pharmaceutical, Teijin Pharma), research grant (Eisai, Daiichi-Sankyo, Takeda Pharmaceutical). Shunji Takahashi: lecture fee (Eisai, Daiichi-Sankyo), research grant (AstraZeneca, Daiichi-Sankyo, Chugai Pharmaceutical, Novartis Pharma, Bayer, Parexel International). Akira Taguchi: lecture fee (Asahi Kasei Pharma, MSD, Ono Pharmaceutical, Daiichi-Sankyo, Takeda Pharmaceutical, Chugai Pharmaceutical, Teijin Pharma), consultant fee (Asahi Kasei Pharma). Hiroshi Hagino: lecture fee (Asahi Kasei Pharma, EA Pharma, MSD, Daiichi-Sankyo, Taisho Toyama Pharmaceutical, Takeda Pharmaceutical, Chugai Pharmaceutical, Pfizer), research grant (Chugai Pharmaceutical). Masahiro Urade: none. Takahiko Shibahara: none. Satoru Toyosawa: none. Toshihiko Nagata: none.

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Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan 2016

Authors and Affiliations

  • Japanese Allied Committee on Osteonecrosis of the Jaw
  • Toshiyuki Yoneda
    • 1
    • 12
  • Hiroshi Hagino
    • 2
    • 12
  • Toshitsugu Sugimoto
    • 3
    • 12
  • Hiroaki Ohta
    • 4
    • 13
  • Shunji Takahashi
    • 5
    • 12
  • Satoshi Soen
    • 6
    • 13
  • Akira Taguchi
    • 7
    • 14
  • Toshihiko Nagata
    • 9
    • 15
  • Masahiro Urade
    • 10
    • 16
  • Takahiko Shibahara
    • 11
    • 16
  • Satoru Toyosawa
    • 8
    • 17
  1. 1.Division of Hematology and OncologyIndiana University School of MedicineIndianapolisUSA
  2. 2.School of Health Science, Faculty of MedicineTottori UniversityTottoriJapan
  3. 3.Internal Medicine 1Shimane University Faculty of MedicineMatsueJapan
  4. 4.Clinical Research Centers for MedicineInternational University of Health and WelfareOhtawaraJapan
  5. 5.Department of Medical OncologyThe Cancer Institute Hospital Of Japanese Foundation of Cancer ResearchTokyoJapan
  6. 6.Department of Orthopaedic Surgery and RheumatologyKindai University Nara HospitalIkomaJapan
  7. 7.Department of Hard Tissue ResearchGraduate School of Oral Medicine, Matsumoto Dental UniversityShiojiriJapan
  8. 8.Department of Oral PathologyOsaka University Graduate School of DentistrySuitaJapan
  9. 9.Department of Periodontology and Endodontology, School of DentistryTokushima UniversityTokushimaJapan
  10. 10.Department of Oral and Maxillofacial SurgeryHyogo College of MedicineNishinomiyaJapan
  11. 11.Department of Oral and Maxillo-Facial SurgeryTokyo Dental CollegeTokyoJapan
  12. 12.The Japanese Society for Bone and Mineral ResearchKyotoJapan
  13. 13.The Japan Osteoporosis SocietyTokyoJapan
  14. 14.The Japanese Society of Oral and Maxillofacial RadiologyTokyoJapan
  15. 15.The Japanese Society of PeriodontologyTokyoJapan
  16. 16.The Japanese Society of Oral and Maxillofacial SurgeonsTokyoJapan
  17. 17.The Japanese Society of Oral PathologyTokyoJapan

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