Clinical management of maxillary osteonecrosis associated with antiresorptive medication (MRONJ): Presentation of clinical cases
Abstract
Antiresorptive drugs: Bisphosphonates (BPs) and Monoclonal Antibodies: Denosumab (DS) are known to suppress osteoclastic activity, affecting the expression of the RANKL (Kappa β Nuclear Activation Receptor), which corresponds to an osteoblastic differentiation factor and which is secreted by said cells, being responsible for inducing reabsorption by osteoclasts. Under certain circumstances, those medications may induce the development of Maxillary Osteonecrosis (MRONJ).
The paper is aimed to share our experience of MRONJ treatment using minimally invasive therapies (including washes and antibiotics) that does not expand the necrotic bed volumetrically and provide non-recurrent resolution of the lesion. The patients we described were on long-term therapy either with BPs or DS.
Conclusion: Interaction between health professional is essential for MRONJ prevention. The therapeutics consolidated in non-invasive maneuvers, and the manipulation of bone tissue with close follow up allows to avoid spread to deep planes. The pathological process could be successfully treated, and it is not necessary to suspend antiresorptive medications.
References
Picardo SN, Rey EA. Clinical Healthcare Protocol for Bisphosphonate Related Osteonecrosis of The Jaw. International Journal of Dentistry and Oral Health 2017; 3: 42-44.
Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK et al. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 2015; 30(1): 3-23. doi: 10.1002/jbmr.2405.
Fleisher KE, Kontio R, Otto S Antiresortive drug-related ostenecrosis of the jaw (ARONJ), a guide to research. AOCMF; Switzerland; 2016.
Paparella ML, Brandizzi D, Santini Araujo E, Cabrini RL. Osteonecrosis of the Jaw Associated with Bosphosphonates. A. Histopathological Study of 24 Cases. JMS Dent 2014; 2(3): 1037
Fung PL. The GENVABO study-genetic variants as biomarkers of jaw osteonecrosis associated with bisphosphonates: a large, multicenter genome-wide association study and detailed analyses of clinical phenotype. Doctoral Thesis: Institute, University College London, 2015.
Picardo SN, Rey E. Osteonecrosis of The Jaw in Patients Undergoing Long-term Treatment with Bisphosphonates: Incidence and Associated Characteristics. Journal of Clinical and Medical Case Study 2017; 2;48-54.
Dhanda J, Pasquier D, Newman L, Shaw R. Current Concepts in Osteoradionecrosis after Head and Neck Radiotherapy. Clin Oncol (R Coll Radiol) 2016; 28(7): 459-66. doi: 10.6696/IJHNS.201906_3(2).0003.
Bone HG, Wagman RB, Brandi ML, Brown JP, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the face 3 randomized FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol 2017; 5 (7):513-523. doi.org/10.1016/S2213-8587(17)30138-9. Cummins S R, Ferrari S, Eastell R, Gilchrist N, et al.Vertebral Fractures After Discontinuation of Denosumab: A PSot Hoc Analysis of the Randomized Placebo-Controled FREEDOM Trial and Its Extension. J Bone Miner R 2018 33(2): 190-198. doi: 10.1002/jbmr.3337.
Marx RE, Cillo JE Jr, Ulloa JJ. Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg. 2007 65(12): 2397-410. doi: 10.1016/j.joms.2007.08.003.
Limones A. Sáez-Alcaide LM, Díaz-Parreñp SA, Helm A, Bornstein M, Molinero-Mouelle P. Medication-related osteonecrosis of the jaws (MRONJ) in cancer patients treated with denosumab Vs zoledronic acid: A systematic review and meta-analysis. Med Oral Patol Cir Bucal. 2020; 25(3): 326-336. doi: 10.4317/medoral.23324
Burr DB, ASBMR Task Force. Summary of ASBMR Task Force on ONJ. J. Musculoskelet Neuronal Interact. 2007; 7(4):354-5.
Kim KM, Rhee Y, Dae Kwon Y, Geo-Kwon T, Lee JK, Yoon Kim D. Medication related Osteonecrosis of the jaw: 2015 Position Statement of the Korean Society for bone and Mineral Research and the Korean Association of Maxillo Facial Surgeons; J Bone Metab. 2015; 22: 151-165
Ruggiero S, Saxena D, Tetradis S, Aghaloo T, Ioannidou E. Task Force on Design and Analysis in Oral Health Research: Medication-Related Osteonecrosis of the Jaw. JDR Clin Trans Res. 2018; 3(3): 222-225.3
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