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Antiresorptiva-assoziierte Kiefernekrose – Update 2023

Antiresorptive drug-related osteonecrosis of the jaw—2023 update

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best practice onkologie Aims and scope

Zusammenfassung

Die antiresorptivaassoziierte Kiefernekrose ist eine seltene, aber alle beteiligten Behandler herausfordernde Erkrankung. Vor allem das Risiko und die Häufigkeitsraten, an dieser seltenen Nebenwirkung zu erkranken, sorgen immer wieder für kontroverse Diskussionen. Dabei muss es das Ziel sein, unabhängig vom Risikoprofil, jeden Patienten vor dieser Therapiefolge zu bewahren. Denn bei verzögerter Diagnose und Therapie kann sich die antiresorptivaassoziierte Kiefernekrose zu einem ausgeprägten, die Lebensqualität einschränkenden Krankheitsbild entwickeln. Seit der Erstbeschreibung dieses Krankheitsbildes im Jahr 2003 sind große Fortschritte im Verständnis der multifaktoriellen Pathogenese und der daraus abgeleiteten vorbeugenden und therapeutischen Maßnahmen errungen worden. Eine frühe Aufklärung der Patienten, der interdisziplinäre Austausch und die Zusammenarbeit aller beteiligten Fachdisziplinen sind von großer Bedeutung für die patientenspezifische Risikominimierung und Etablierung einer erfolgreichen Therapie.

Abstract

Antiresorptive drug-related osteonecrosis of the jaw is a rare but challenging condition for all involved practitioners. In particular, the risk and prevalence rates of developing this rare side effect continues to be controversial. The goal must be to protect every patient from this therapeutic consequence, regardless of the risk profile. If diagnosis and therapy are delayed, antiresorptive drug-related osteonecrosis of the jaw can develop into a pronounced clinical picture that limits quality of life. Since the initial description of this clinical picture in 2003, great progress has been made in understanding the multifactorial pathogenesis and also preventive and therapeutic measures derived from it. Early patient education, interdisciplinary exchange, and cooperation of all involved disciplines are paramount for patient-specific risk minimization and establishment of successful treatment.

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Literatur

  1. Schiegnitz E et al (2018) S3 Leitlinie Antiresorptiva-assoziierte Kiefernekrosen (AR-ONJ). AWMF-Register-Nr. 007-091. AWMF

    Google Scholar 

  2. Otto S et al (2018) Medication-related osteonecrosis of the jaw: prevention, diagnosis and management in patients with cancer and bone metastases. Cancer Treat Rev 69:177–187

    Article  PubMed  Google Scholar 

  3. Papapoulos S et al (2015) The effect of 8 or 5 years of denosumab treatment in postmenopausal women with osteoporosis: results from the FREEDOM extension study. Osteoporos Int 26(12):2773–2783

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. L.d.D.d.D.W.O.G.e.V. (2017) S3-Leitlinie Prophylaxe, Diagnostik und Therapie der Osteoporose. AWMF-Register-Nr. 183-001. AWMF

    Google Scholar 

  5. Dearnaley DP et al (2009) Adjuvant therapy with oral sodium clodronate in locally advanced and metastatic prostate cancer: long-term overall survival results from the MRC PR04 and PR05 randomised controlled trials. Lancet Oncol 10(9):872–876

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Ristow O et al (2015) Treatment perspectives for medication-related osteonecrosis of the jaw (MRONJ). J Craniomaxillofac Surg 43(2):290–293

    Article  PubMed  Google Scholar 

  7. Schiodt M et al (2019) Workshop of European task force on medication-related osteonecrosis of the jaw-Current challenges. Oral Dis 25(7):1815–1821

    Article  PubMed  Google Scholar 

  8. Ruggiero SL et al (2022) American Association of Oral and Maxillofacial Surgeons’ position paper on medication-related osteonecrosis of the jaws-2022 update. J Oral Maxillofac Surg 80(5):920–943

    Article  PubMed  Google Scholar 

  9. Schiodt M (2019) When and how to extract teeth under antiresorptive treatment—Guidelines for the dental practitioner in Denmark. In: 3rd International Symposium on Medication Related Osteonecrosis of the Jaw (MRONJ). 2019. Copenhagen, Denmark

    Google Scholar 

  10. Ruggiero SL et al (2014) American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg 72(10):1938–1956

    Article  PubMed  Google Scholar 

  11. Ristow O et al (2021) Diagnostic accuracy comparing OPT and CBCT in the detection of non-vital bone changes before tooth extractions in patients with antiresorptive intake. Oral Dis 29(3):1039–1049 https://doi.org/10.1111/odi.14048

    Article  PubMed  Google Scholar 

  12. Ristow O et al (2021) A critical assessment of the medication-related osteonecrosis of the jaw classification in stage I patients: a retrospective analysis. J Korean Assoc Oral Maxillofac Surg 47(2):99–111

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ristow O et al (2018) Double-layer closure techniques after bone surgery of medication-related osteonecrosis of the jaw—A single center cohort study. J Craniomaxillofac Surg 46(5):815–824

    Article  PubMed  Google Scholar 

  14. Otto S et al (2010) Osteonecrosis of the jaw: effect of bisphosphonate type, local concentration, and acidic milieu on the pathomechanism. J Oral Maxillofac Surg 68(11):2837–2845

    Article  PubMed  Google Scholar 

  15. Otto S et al (2021) Infection as an important factor in medication-related osteonecrosis of the jaw (MRONJ). Medicina (Kaunas) https://doi.org/10.3390/medicina57050463

    Article  PubMed  Google Scholar 

  16. Kunihara T et al (2023) Incidence and trend of antiresorptive agent-related osteonecrosis of the jaw from 2016 to 2020 in Kure, Japan. Osteoporos Int 34(6):1101–1109

    Article  PubMed  PubMed Central  Google Scholar 

  17. Peng J et al (2022) Real-world study of antiresorptive-related osteonecrosis of jaw based on the US food and drug administration adverse event reporting system database. Front Pharmacol 13:1017391

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Coleman R et al (2013) Zoledronic acid (zoledronate) for postmenopausal women with early breast cancer receiving adjuvant letrozole (ZO-FAST study): final 60-month results. Ann Oncol 24(2):398–405

    Article  CAS  PubMed  Google Scholar 

  19. Van Poznak CH et al (2021) Association of osteonecrosis of the jaw with zoledronic acid treatment for bone metastases in patients with cancer. JAMA Oncol 7(2):246–254

    Article  PubMed  Google Scholar 

  20. Ikesue H et al (2022) Risk evaluation of denosumab and zoledronic acid for medication-related osteonecrosis of the jaw in patients with bone metastases: a propensity score-matched analysis. Support Care Cancer 30(3):2341–2348

    Article  PubMed  Google Scholar 

  21. Ikesue H et al (2021) Switching from zoledronic acid to denosumab increases the risk for developing medication-related osteonecrosis of the jaw in patients with bone metastases. Cancer Chemother Pharmacol 87(6):871–877

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Coleman R et al (2020) Adjuvant denosumab in early breast cancer (D-CARE): an international, multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 21(1):60–72

    Article  CAS  PubMed  Google Scholar 

  23. Vliek SB et al (2022) Daily oral ibandronate with adjuvant endocrine therapy in postmenopausal women with estrogen receptor-positive breast cancer (BOOG 2006-04): randomized phase III TEAM-IIB trial. J Clin Oncol 40(25):2934–2945

    Article  CAS  PubMed  Google Scholar 

  24. Fusco V et al (2020) Comment on medication-related osteonecrosis of the jaw: MASCC/ISOO/ASCO clinical practice guideline summary. JCO Oncol Pract 16(3):142–145

    Article  PubMed  Google Scholar 

  25. Hata H et al (2022) Prognosis by cancer type and incidence of zoledronic acid-related osteonecrosis of the jaw: a single-center retrospective study. Support Care Cancer 30(5):4505–4514

    Article  PubMed  Google Scholar 

  26. Ahdi HS et al (2023) Medication-induced osteonecrosis of the jaw: a review of cases from the Food and Drug Administration Adverse Event Reporting System (FAERS). BMC Pharmacol Toxicol 24(1):15

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Ruckschloss T et al (2021) Influence of preventive tooth extractions on quality of life in patients with antiresorptive intake—A prospective longitudinal study. Int J Environ Res Public Health 18 https://doi.org/10.3390/ijerph18211165

    Article  PubMed  PubMed Central  Google Scholar 

  28. Beth-Tasdogan NH et al (2022) Interventions for managing medication-related osteonecrosis of the jaw. Cochrane Database Syst Rev 7(7):CD12432

    PubMed  Google Scholar 

  29. Pautke C et al (2021) The type of antiresorptive treatment influences the time to onset and the surgical outcome of medication-related osteonecrosis of the jaw. J Oral Maxillofac Surg 79(3):611–621

    Article  PubMed  Google Scholar 

  30. Martins LHI et al (2021) Oral Dis 29(1):75–99 https://doi.org/10.1111/odi.14003

    Article  PubMed  Google Scholar 

  31. Romero-Ruiz MM et al (2021) Proposal for a preventive protocol for medication-related osteonecrosis of the jaw. Med Oral Patol Oral Cir Bucal 26(3):e314–e326

    Article  PubMed  Google Scholar 

  32. Nicolatou-Galitis O et al (2020) Alveolar bone histological necrosis observed prior to extractions in patients, who received bone-targeting agents. Oral Dis 26(5):955–966

    Article  PubMed  Google Scholar 

  33. Otto S et al (2015) Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: a trigger for BRONJ development? J Craniomaxillofac Surg 43(6):847-54 https://doi.org/10.1016/j.jcms.2015.03.03

  34. Ristow O et al (2021) Wound closure and alveoplasty after preventive tooth extractions in patients with antiresorptive intake—A randomized pilot trial. Oral Dis 27(3):532–546

    Article  PubMed  Google Scholar 

  35. Matsumoto A et al (2017) Primary wound closure after tooth extraction for prevention of medication-related osteonecrosis of the jaw in patients under denosumab. Clin Oral Investig 21(1):127–134

    Article  PubMed  Google Scholar 

  36. Ottesen C et al (2022) Tooth extractions in patients with cancer receiving high-dose antiresorptive medication: a randomized clinical feasibility trial of drug holiday versus drug continuation. Oral Surg Oral Med Oral Pathol Oral Radiol 133(2):165–173

    Article  PubMed  Google Scholar 

  37. Otto S et al (2020) A drug holiday reduces the frequency and severity of medication-related osteonecrosis of the jaw in a minipig model. J Bone Miner Res 35(11):2179–2192

    Article  CAS  PubMed  Google Scholar 

  38. Ristow O et al (2017) Comparison of auto-fluorescence and tetracycline fluorescence for guided bone surgery of medication-related osteonecrosis of the jaw: a randomized controlled feasibility study. Int J Oral Maxillofac Surg 46(2):157–166

    Article  CAS  PubMed  Google Scholar 

  39. Ristow O et al (2019) Is the conservative non-surgical management of medication-related osteonecrosis of the jaw an appropriate treatment option for early stages? A long-term single-center cohort study. J Craniomaxillofac Surg 47(3):491–499

    Article  PubMed  Google Scholar 

  40. Hoefert S et al (2017) Clinical course and therapeutic outcomes of operatively and non-operatively managed patients with denosumab-related osteonecrosis of the jaw (DRONJ). J Craniomaxillofac Surg 45(4):570–578

    Article  PubMed  Google Scholar 

  41. Bensi C et al (2021) Quality of life in patients affected by medication-related osteonecrosis of the jaws: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 132(2):182–189

    Article  PubMed  Google Scholar 

  42. Miksad RA et al (2011) Quality of life implications of bisphosphonate-associated osteonecrosis of the jaw. Oncologist 16(1):121–132

    Article  PubMed  PubMed Central  Google Scholar 

  43. Winter A et al (2022) Oral-health-related quality of life in patients with medication-related osteonecrosis of the jaw: a prospective clinical study. Int J Environ Res Public Health 19(18) https://doi.org/10.3390/ijerph191811709

    Article  PubMed  PubMed Central  Google Scholar 

  44. Hayashida S et al (2017) Evaluation of the treatment strategies for medication-related osteonecrosis of the jaws (MRONJ) and the factors affecting treatment outcome: a multicenter retrospective study with propensity score matching analysis. J Bone Miner Res 32(10):2022–2029

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    Oliver Ristow,  Thomas Rückschloß, Gregor Schnug, Maximilian Smielowski, Maximilian Appel &  Jürgen Hoffmann

  2. Klinik für Mund‑, Kiefer- und Gesichtschirurgie, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden und Tagesklinik für MKG-Chirurgie in der Burgstraße, Burgstr. 2–4, 65183, Wiesbaden, Deutschland

    Knut A. Grötz

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  1. Oliver Ristow
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  4. Maximilian Smielowski
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Correspondence to Oliver Ristow.

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Interessenkonflikt

O. Ristow, T. Rückschloß, G. Schnug, M. Smielowski, M. Appel, J. Hoffmann und K.A. Grötz geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Andreas Kurth, Mainz

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Ristow, O., Rückschloß, T., Schnug, G. et al. Antiresorptiva-assoziierte Kiefernekrose – Update 2023. best practice onkologie 18, 348–361 (2023). https://doi.org/10.1007/s11654-023-00517-5

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