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Prevalence of medication related osteonecrosis of the jaw in patients treated with sequential antiresorptive drugs: systematic review and meta-analysis

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Abstract

Background

Antiresorptive drugs (ARD) are associated with a known serious adverse event, known as medication-related osteonecrosis of the jaws (MRONJ). Transition from one ARD to another has become common clinical practice with the advent of more potent or safer agents; however, the influence of sequential antiresorptive therapy as a risk factor for MRONJ has not been established.

Objectives

To investigate the prevalence of MRONJ in oncology or osteoporosis patients treated with two or more sequential ARDs as opposed to a single antiresorptive drug.

Material and methods

Systematic electronic literature searches were conducted using Ovid MEDLINE, Ovid EMBASE, and Cochrane Central Register of Controlled Trials. Two review authors retrieved studies using pre-determined eligibility criteria and conducted quality assessment and data extraction. Fixed or random-effects meta-analysis models were used to summarize relative estimates for prevalence of MRONJ.

Results

A total of 483 titles and abstracts were screened, and 18 full texts were retrieved for review. Twelve studies were included in the final qualitative and quantitative synthesis. Random effects meta-analysis models revealed a weighted pooled MRONJ prevalence of 19% (95% CI 10–27%) for sequential pamidronate-zoledronate therapy, 10% (95% CI 3–22%) for sequential ibandronate-zoledronate therapy. Pooled weighted prevalence of MRONJ was 13% (95% CI 3–22%) for sequential bisphosphonate-denosumab therapy while bisphosphonates only was 5% (95% CI 0–9%) and denosumab only was 4% (95% CI 3–5%).

Conclusions

The present systematic review suggests an increased prevalence of MRONJ associated with sequential ARD therapy for pamidronate-zoledronate and bisphosphonate-denosumab administration when compared to single ARD therapy.

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Funding

This work was supported in part by the Cancer Center Support Grant (NCI Grant P30 CA016672).

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Authors and Affiliations

  1. Department of Restorative Dentistry & Prosthodontics, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge, Suite 5350, Houston, TX, 77054, USA

    Akanksha Srivastava

  2. Section of Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, Division of Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Alexander M. Won & Mark S. Chambers

  3. Department of Biostatistics, Division of Quantitative Sciences, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Graciela M. Nogueras Gonzalez & Yisheng Li

  4. Research Medical Library, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Yimin Geng

  5. Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Maria E. Cabanillas

  6. Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Aung Naing

  7. Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeffrey N. Myers

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  1. Akanksha Srivastava
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Contributions

Study conceptualization: Akanksha Srivastava, Mark S Chambers; literature search: Akanksha Srivastava, Yimin Geng, and Mark S Chambers; data analysis: Akanksha Srivastava, Graciela M Nogueras Gonzalez, Yisheng Li, and Mark S Chambers. Writing–original draft preparation: Akanksha Srivastava. Writing: interpretation, critical revision, and editing: all authors. All authors read and approved the final manuscript.

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Srivastava, A., Nogueras Gonzalez, G.M., Geng, Y. et al. Prevalence of medication related osteonecrosis of the jaw in patients treated with sequential antiresorptive drugs: systematic review and meta-analysis. Support Care Cancer 29, 2305–2317 (2021). https://doi.org/10.1007/s00520-020-05882-3

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