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

Journal of Bone and Mineral Metabolism volume 35, pages 6–19 (2017)Cite this article

An Erratum to this article was published on 24 January 2017

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.

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Author information

Authors and Affiliations

  1. Division of Hematology and Oncology, Indiana University School of Medicine, Indianapolis, USA

    Toshiyuki Yoneda

  2. School of Health Science, Faculty of Medicine, Tottori University, Tottori, Japan

    Hiroshi Hagino

  3. Internal Medicine 1, Shimane University Faculty of Medicine, Matsue, Japan

    Toshitsugu Sugimoto

  4. Clinical Research Centers for Medicine, International University of Health and Welfare, Ohtawara, Japan

    Hiroaki Ohta

  5. Department of Medical Oncology, The Cancer Institute Hospital Of Japanese Foundation of Cancer Research, Tokyo, Japan

    Shunji Takahashi

  6. Department of Orthopaedic Surgery and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan

    Satoshi Soen

  7. Department of Hard Tissue Research, Graduate School of Oral Medicine, Matsumoto Dental University, Shiojiri, Japan

    Akira Taguchi

  8. Department of Oral Pathology, Osaka University Graduate School of Dentistry, Suita, Japan

    Satoru Toyosawa

  9. Department of Periodontology and Endodontology, School of Dentistry, Tokushima University, Tokushima, Japan

    Toshihiko Nagata

  10. Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Japan

    Masahiro Urade

  11. Department of Oral and Maxillo-Facial Surgery, Tokyo Dental College, Tokyo, Japan

    Takahiko Shibahara

  12. The Japanese Society for Bone and Mineral Research, Kyoto, Japan

    Toshiyuki Yoneda, Hiroshi Hagino, Toshitsugu Sugimoto & Shunji Takahashi

  13. The Japan Osteoporosis Society, Tokyo, Japan

    Hiroaki Ohta & Satoshi Soen

  14. The Japanese Society of Oral and Maxillofacial Radiology, Tokyo, Japan

    Akira Taguchi

  15. The Japanese Society of Periodontology, Tokyo, Japan

    Toshihiko Nagata

  16. The Japanese Society of Oral and Maxillofacial Surgeons, Tokyo, Japan

    Masahiro Urade & Takahiko Shibahara

  17. The Japanese Society of Oral Pathology, Tokyo, Japan

    Satoru Toyosawa

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  1. Toshiyuki Yoneda
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Correspondence to Toshiyuki Yoneda.

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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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An erratum to this article is available at http://dx.doi.org/10.1007/s00774-017-0816-9.

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Japanese Allied Committee on Osteonecrosis of the Jaw., Yoneda, T., Hagino, H. et al. Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw. J Bone Miner Metab 35, 6–19 (2017). https://doi.org/10.1007/s00774-016-0810-7

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Keywords

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