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Therapeutic approach and management algorithms in medication-related osteonecrosis of the jaw (MONJ): recommendations of a multidisciplinary group of experts

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Abstract

Background

The justification for this consensus is the absence of local protocols on Medication-Related Osteonecrosis of the Jaws (MONJ), for prevention, evaluation, and treatment, involving physicians and dentists, leading to suspension of antiresorptive treatments, despite their benefit in the prevention of fragility fractures (40–70%). These fractures cause disability and mortality (80% and 20–30%, respectively), as opposed to the low risk associated with MONJ in osteoporotic (0.01–0.03%) and oncological patients (1.3–1.8%).

Purpose

To provide management recommendations through algorithms that guide health professionals to prevent, diagnose, and treat MONJ in different clinical scenarios.

Method

A technical multidisciplinary team composed of specialists with extensive experience in osteoporosis or osteonecrosis of the jaw from Fundación Santa Fé (Bogotá, Colombia) and the Asociación Colombiana de Osteoporosis y Metabolismo Mineral was selected. Three rounds were carried out: definition of questions, answers using Delphi methodology, and the discussion of questions in order to have an agreement. The whole group participated in two phases, and the developer group in the total number of rounds. A literature review was conducted to obtain academic support to design questions with clinical relevance.

Results and conclusions

The consensus group generated definitions and recommendations useful for doctors and dentists, following clinical algorithms involving four scenarios: osteoporosis patient who requires dental procedures and has not received antiresorptives, osteoporosis patient who are under treatment with antiresorptives, cancer patients, and MONJ-instituted patients. The therapeutic approach in osteoporosis and cancer patients, in invasive dental procedures, must be relied on the risk-benefit treatment.

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Acknowledgments

We are thankful to the Asociación Colombiana de Osteoporosis y Metabolismo Mineral (ACOMM) by the organization and participation on publication process of this consensus and to the group Hueso saludable from the Fundación Santa Fé de Bogotá, by the project´s iniciative. We are also grateful to Andres Coy, Endocrinologist, Hospital San Jose, Bogotá, Colombia, and Danielle Sieve, San Francisco, California, USA, for their help translating this manuscript.

Author information

Authors and Affiliations

  1. Rheumatology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia

    Monique Chalem

  2. Endocrinology Department, Hospital de San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia

    Adriana Medina

  3. Maxillofacial Surgery Department, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá, Colombia

    Ana Karina Sarmiento

  4. Endocrinology Department, Fundacion Santa Fe de Bogota, Universidad de los Andes, Bogota, Colombia

    Deyanira Gonzalez

  5. Orthopedic Surgery Department, Fundacion Santa Fe de Bogota, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia

    Carlos Olarte

  6. Orthopedic Surgery Department, Fundacion Santa Fe de Bogota, Universidad del Rosario, Bogota, Colombia

    Edgar Pinilla

  7. Geriatric Department, Fundacion Santa Fe de Bogota, Bogota, Colombia

    Jorge Paz

  8. Rheumatology Department, Colsanitas, Bogota, Colombia

    Noemi Casas

  9. Fundacion Santa Fe, Bogota, Colombia

    Maria Paula Vega

  10. Bogota, Colombia

    Edna Diaz

Authors
  1. Monique Chalem
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  2. Adriana Medina
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  3. Ana Karina Sarmiento
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  4. Deyanira Gonzalez
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  5. Carlos Olarte
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  6. Edgar Pinilla
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  7. Jorge Paz
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  8. Noemi Casas
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  9. Maria Paula Vega
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  10. Edna Diaz
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Corresponding author

Correspondence to Adriana Medina.

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Chalem, M., Medina, A., Sarmiento, A.K. et al. Therapeutic approach and management algorithms in medication-related osteonecrosis of the jaw (MONJ): recommendations of a multidisciplinary group of experts. Arch Osteoporos 15, 101 (2020). https://doi.org/10.1007/s11657-020-00761-0

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  • DOI: https://doi.org/10.1007/s11657-020-00761-0

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