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Oral risk factors associated with medication-related osteonecrosis of the jaw in patients with cancer

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Abstract

Introduction

Bone-modifying agents (BMAs) are indispensable to cancer therapy. However, the number of patients with medication-related osteonecrosis of the jaw (MRONJ) is increasing according to the BMA administration. Oral factors predisposing to development of MRONJ are receiving attention, and oral management is recommended for prevention of MRONJ; however, the strategy and criteria have not yet been established. Therefore, we investigated the oral risk factors associated with MRONJ development in this study.

Materials and Methods

A retrospective study was carried out on 398 cancer patients who had received oncological-dose BMAs between 2007 and 2018; general health factors, demographic, and dental factors were examined along with MRONJ development in all the patients. The cumulative occurrence rate of MRONJ was calculated using a Kaplan–Meier analysis. Clinical factors were analyzed using the Cox regression analysis.

Results

MRONJ occurred in 42 of the 398 patients. The cumulative MRONJ incidence rates were 4.5, 12.9, 17.7, and 21.6% at 1, 2, 3, and 4 years, respectively. Age (p = 0.038), male sex (p = 0.002), initiation of dental interventions before BMA administration (p = 0.020), alveolar bone loss involving more than half the root (p < 0.001), and torus mandibularis (p < 0.001) were significantly associated with MRONJ.

Conclusions

Our findings suggest that patients with alveolar bone loss involving more than half the root on panoramic radiographs and torus mandibularis carry a high risk of MRONJ development. Early dental intervention before BMA administration and oral management during the treatment are important for preventing MRONJ.

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Acknowledgments

We would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Nobuhiro Ueda, Kumiko Aoki, Hiroko Shimotsuji, Chie Nakashima, Mao Kawakami, Yuichiro Imai & Tadaaki Kirita

  2. Department of Oral and Maxillofacial Surgery, Rakuwakai Otowa Hospital, 2 Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan

    Yuichiro Imai

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  1. Nobuhiro Ueda
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  2. Kumiko Aoki
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  3. Hiroko Shimotsuji
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  4. Chie Nakashima
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  5. Mao Kawakami
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  6. Yuichiro Imai
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  7. Tadaaki Kirita
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Contributions

Study design: NU and CN. Data collection: HS. Data analysis: NU. Data interpretation: CN and TK. Drafting manuscript: NU. Revising manuscript: NU, KA, HS, CN, MK, YI, and TK. NU accepted the responsibility for the integrity of the data analysis. All authors agreed to be accountable for all the aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Nobuhiro Ueda.

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All authors have no conflicts of interest.

Ethical approval

This study was approved by the institutional review board of the Nara Medical University Hospital (Receipt No. 2184).

Informed consent

This study did not require patient consent because of its retrospective nature; therefore, we published the research plan on the homepage of our hospital’s website and guaranteed an opt-out opportunity according to the instructions of the IRB.

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Ueda, N., Aoki, K., Shimotsuji, H. et al. Oral risk factors associated with medication-related osteonecrosis of the jaw in patients with cancer. J Bone Miner Metab 39, 623–630 (2021). https://doi.org/10.1007/s00774-020-01195-x

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  • DOI: https://doi.org/10.1007/s00774-020-01195-x

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