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Clinical significance of drug cessation on medication-related osteonecrosis of the jaw in patients with osteoporosis

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Objectives: Suspending bisphosphonates (BPs) to reduce the risk and severity of medication-related osteonecrosis of the jaw (MRONJ) remains controversial. In this study, we quantitatively evaluated the clinical significance of BP suspension before surgery in osteoporosis patients with MRONJ. Materials and Methods: We analyzed 24 osteoporosis patients with MRONJ who were treated from 2012 to 2020 at Seoul National University Dental Hospital and compared the treatment outcomes of those who suspended BPs with those who did not. The number of surgical interventions, follow-up panoramic radiographs for relative bone density measurement, and laboratory blood tests including white blood cells, erythrocyte sedimentation rate, absolute neutrophil count, hemoglobin, hematocrit, and alkaline phosphatase were analyzed. ANOVA, Student’s t -test, and Mann–Whitney U tests were used to compare results. Fisher’s exact test was used to discover the association between treatment outcome and BP suspension, and Pearson’s correlation test was used to measure the statistical relationship between the changes in serum inflammatory markers. Results: The number of interventions was significantly higher in the non-drug suspension group due to recurrence (P<0.05). The relative bone density in patients who suspended BPs was significantly different over time (P<0.05), with the highest density at one-year follow-up. Fisher’s exact test shows an association between successful treatment outcomes and BP suspension. The alkaline phosphatase and erythrocyte sedimentation rate levels decreased significantly in the BP-suspended group, and a positive correlation was found between these elevated markers. Conclusion: A significant increase in bone density throughout follow-up and a lower number of interventions were found in the BP suspension group compared to the non-drug suspension group. Also, BP suspension decreased inflammatory markers in the serum after surgery, resulting in good treatment outcomes. BP suspension is a prognostic factor for MRONJ and should be implemented before surgery.

Abstract

Objectives: Suspending bisphosphonates (BPs) to reduce the risk and severity of medication-related osteonecrosis of the jaw (MRONJ) remains controversial. In this study, we quantitatively evaluated the clinical significance of BP suspension before surgery in osteoporosis patients with MRONJ. Materials and Methods: We analyzed 24 osteoporosis patients with MRONJ who were treated from 2012 to 2020 at Seoul National University Dental Hospital and compared the treatment outcomes of those who suspended BPs with those who did not. The number of surgical interventions, follow-up panoramic radiographs for relative bone density measurement, and laboratory blood tests including white blood cells, erythrocyte sedimentation rate, absolute neutrophil count, hemoglobin, hematocrit, and alkaline phosphatase were analyzed. ANOVA, Student’s t -test, and Mann–Whitney U tests were used to compare results. Fisher’s exact test was used to discover the association between treatment outcome and BP suspension, and Pearson’s correlation test was used to measure the statistical relationship between the changes in serum inflammatory markers. Results: The number of interventions was significantly higher in the non-drug suspension group due to recurrence (P<0.05). The relative bone density in patients who suspended BPs was significantly different over time (P<0.05), with the highest density at one-year follow-up. Fisher’s exact test shows an association between successful treatment outcomes and BP suspension. The alkaline phosphatase and erythrocyte sedimentation rate levels decreased significantly in the BP-suspended group, and a positive correlation was found between these elevated markers. Conclusion: A significant increase in bone density throughout follow-up and a lower number of interventions were found in the BP suspension group compared to the non-drug suspension group. Also, BP suspension decreased inflammatory markers in the serum after surgery, resulting in good treatment outcomes. BP suspension is a prognostic factor for MRONJ and should be implemented before surgery.

참고문헌 (48)

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Drug holiday as a prognostic factor of medication-related osteonecrosis of the jaw김윤호, 송승일, 이정근, 이호경대한구강악안면외과학회 · 대한구강악안면외과학회지2014 · 제40권 제5호The effect of bisphosphonate discontinuation on the incidence of postoperative medication-related osteonecrosis of the jaw after tooth extraction강상훈, 김문기, 박세진대한구강악안면외과학회 · 대한구강악안면외과학회지2020 · 제46권 제1호Clinical characteristics and recurrence-related factors of medication-related osteonecrosis of the jaw강몽헌, 김창우, 송인석, 이동건, 전상호대한구강악안면외과학회 · 대한구강악안면외과학회지2018 · 제44권 제5호Medication-related osteonecrosis of the jaw: an evidence-based 2025 position statement from a Korean multidisciplinary task forceBaek Seung-Hoon, Choi Han Seok, Choi Yong Jun, Han Jeong Joon, Kim Beom-Jun, Kim BeomTaek, Kim Ha Young, Kim Jae-Young, Kim Jin-Woo, Kim Jun-Young, Kim Moon-Young, Kim Sun-Jong, Kong Sung-Hye, Kwak Mi Kyung, Kwon Tae-Geon, Kwon Yong-Dae, Lee Dong Ock, Lee Young-Kyun, Oh Ji-Hyeon, Park Hyung-Youl, Song Kwang-Sup대한구강악안면외과학회 · 대한구강악안면외과학회지2025 · 제51권 제6호Implant-Related Medication-related Osteonecrosis of the Jaw in Patients Receiving Bone-modifying Agent Therapy손장원, 안강민대한구강악안면임플란트학회 · 대한구강악안면임플란트학회지2024 · 제28권 제4호Recurrence - Related Factors of Medication Related Osteonecrosis of the Jaw (MRONJ) ; a Retrospective study국민석, 김지현, 김혜진, 류재영, 박철영, 박홍주, 오희균, 정승곤, 최경석대한치과의사협회 · 대한치과의사협회지2023 · 제61권 제12호

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