Prognostic factors for outcome of surgical treatment in medication-related osteonecrosis of the jaw
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Objectives: The number of patients with medication-related osteonecrosis of the jaw (MRONJ) is increasing, but treatment remains controversial. Published papers and systematic reviews have suggested that surgical treatment is effective in patients with MRONJ. The purpose of this study was to determine whether preoperative University of Connecticut Osteonecrosis Numerical Scale (UCONNS), other serologic biomarkers, and size of necro-sis are prognostic factors for outcome of surgical treatment in MRONJ.Materials and Methods: From January 2008 to December 2016, 65 patients diagnosed with MRONJ at the Department of Oral and Maxillofacial Surgery in College of Dentistry, Dankook University who required hospitalization and surgical treatment were investigated. Patient information, sys-temic factors, and UCONNS were investigated. In addition, several serologic values were examined through blood tests one week before surgery. The size of osteolysis was measured by panoramic view and cone-beam computed tomography in all patients. With this information, multivariate logistic regression analysis with backward elimination was used to examine factors affecting postoperative outcome. Results: In multivariate logistic analysis, higher UCONNS, higher C-reactive protein (CRP), larger size of osteolysis, and lower serum alkaline phos-phate were associated with higher incidence of incomplete recovery after operation. This shows that UCONNS, CRP, serum alkaline phosphate, and size of osteolysis were statistically significant as factors for predicting postoperative prognosis.Conclusion: This study demonstrated that CRP, UCONNS, serum alkaline phosphate, and size of osteolysis were statistically significant factors in predicting the prognosis of surgical outcome of MRONJ. Among these factors, UCONNS can predict the prognosis of MRONJ surgery as a scale that includes various influencing factors, and UCONNS should be used first as a predictor. More aggressive surgical treatment and more definite surgical margins are needed when the prognosis is poor.
Abstract
Objectives: The number of patients with medication-related osteonecrosis of the jaw (MRONJ) is increasing, but treatment remains controversial. Published papers and systematic reviews have suggested that surgical treatment is effective in patients with MRONJ. The purpose of this study was to determine whether preoperative University of Connecticut Osteonecrosis Numerical Scale (UCONNS), other serologic biomarkers, and size of necro-sis are prognostic factors for outcome of surgical treatment in MRONJ.Materials and Methods: From January 2008 to December 2016, 65 patients diagnosed with MRONJ at the Department of Oral and Maxillofacial Surgery in College of Dentistry, Dankook University who required hospitalization and surgical treatment were investigated. Patient information, sys-temic factors, and UCONNS were investigated. In addition, several serologic values were examined through blood tests one week before surgery. The size of osteolysis was measured by panoramic view and cone-beam computed tomography in all patients. With this information, multivariate logistic regression analysis with backward elimination was used to examine factors affecting postoperative outcome. Results: In multivariate logistic analysis, higher UCONNS, higher C-reactive protein (CRP), larger size of osteolysis, and lower serum alkaline phos-phate were associated with higher incidence of incomplete recovery after operation. This shows that UCONNS, CRP, serum alkaline phosphate, and size of osteolysis were statistically significant as factors for predicting postoperative prognosis.Conclusion: This study demonstrated that CRP, UCONNS, serum alkaline phosphate, and size of osteolysis were statistically significant factors in predicting the prognosis of surgical outcome of MRONJ. Among these factors, UCONNS can predict the prognosis of MRONJ surgery as a scale that includes various influencing factors, and UCONNS should be used first as a predictor. More aggressive surgical treatment and more definite surgical margins are needed when the prognosis is poor.
참고문헌 (34)
- Landesberg R, "Potential pathophysiological mechanisms in osteonecrosis of the jaw", Ann N Y Acad Sci, 1218, pp.62~79 (2011)[DOI]
- Francis MD, "Historical perspectives on the clinical development of bisphosphonates in the treatment of bone diseases", J Musculoskelet Neuronal Interact, 7, pp.2~8 (2007)
- Marx RE, "Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic", J Oral Maxillofac Surg, 61, pp.1115~1117 (2003)[DOI]
- Taylor KH, "Osteonecrosis of the jaws induced by anti-RANK ligand therapy", Br J Oral Maxillofac Surg, 48, pp.221~223 (2010)[DOI]
- Ruggiero SL, "American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update", J Oral Maxillofac Surg, 72, pp.1938~1956 (2014)[DOI]
- Badros A, "Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors", J Clin Oncol, 24, pp.945~952 (2006)[DOI]
- Marx RE, "Bisphosphonateinduced exposed bone (osteonecrosis", osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment, 2005, pp.63, 1567~1575
- Migliorati CA, "Bisphosphonate-associated osteonecrosis of mandibular and maxillary bone: an emerging oral complication of supportive cancer therapy", Cancer, 104, pp.83~93 (2005)[DOI]
- Yoneda T, "Bisphosphonate-related osteonecrosis of the jaw: position paper from the allied task force committee of Japanese Society for Bone and Mineral Research, Japan Osteoporosis Society, Japanese Society of Periodontology, Japanese Society for Oral and Maxillofacial Radiology, and Japanese Society of Oral and Maxillofacial Surgeons", J Bone Miner Metab, 28, pp.365~383 (2010)[DOI]
- Hayashida S, "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, pp.2022~2029 (2017)[DOI]
- Allen MR, "A review of pharmaceutical agents and oral bone health: how osteonecrosis of the jaw has affected the field", Int J Oral Maxillofac Implants, 29, pp.e45~e57 (2014)[DOI]
- Mucke T, "Outcome of treatment and parameters influencing recurrence in patients with bisphosphonate-related osteonecrosis of the jaws", J Cancer Res Clin Oncol, 137, pp.907~913 (2011)[DOI]
- Watters AL, "Intravenous bisphosphonate-related osteonecrosis of the jaw: long-term follow-up of 109 patients", Oral Surg Oral Med Oral Pathol Oral Radiol, 115, pp.192~200 (2013)[DOI]
- Kim JW, "Prospective biomarker evaluation in patients with osteonecrosis of the jaw who received bisphosphonates", Bone, 57, pp.201~205 (2013)[DOI]
- Molcho S, "Diabetes microvascular disease and the risk for bisphosphonate-related osteonecrosis of the jaw: a single center study", J Clin Endocrinol Metab, 98, pp.E1807~E1812 (2013)[DOI]
- Reich W, "Surgical treatment of bisphosphonate-associated osteonecrosis: prognostic score and long-term results", J Craniomaxillofac Surg, 43, pp.1809~1822 (2015)[DOI]
- Lerman MA, "Conservative management of bisphosphonate-related osteonecrosis of the jaws: staging and treatment outcomes", Oral Oncol, 49, pp.977~983 (2013)[DOI]
- Lazarovici TS, "Bisphosphonate-related osteonecrosis of the jaws: a single-center study of 101 patients", J Oral Maxillofac Sug, 67, pp.850~855 (2009)[DOI]
- Kim HY, "Extensive surgical procedures result in better treatment outcomes for bisphosphonate-related osteonecrosis of the jaw in patients with osteoporosis", J Oral Maxillofac Surg, 75, pp.1404~1413 (2017)[DOI]
- Rupel K, "A systematic review of therapeutical approaches in bisphosphonates- related osteonecrosis of the jaw (BRONJ)", Oral Oncol, 50, pp.1049~1057 (2014)[DOI]
- Fliefel R, "Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review", Int J Oral Maxillofac Surg, 44, pp.568~585 (2015)[DOI]
- Khan AA, "Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus", J Bone Miner Res, 30, pp.3~23 (2015)[DOI]
- Hyo Won Jang, "Development of animal model for Bisphosphonates-related osteonecrosis of the jaw (BRONJ)", Maxillofacial Plastic Reconstructive Surgery, 37(7), pp.1~7 (2015), 대한악안면성형재건외과학회[DOI]
- Wutzl A, "Osteonecrosis of the jaws and bisphosphonate treatment in cancer patients", Wien Klin Wochenschr, 118, pp.473~478 (2006)[DOI]
- Ruggiero SL, "Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases", J Oral Maxillofac Surg, 62, pp.527~534 (2004)[DOI]
- Abu-Id MH, "Bisphosphonateassociated osteonecrosis of the jaw", Mund Kiefer Gesichtschir, 10, pp.73~81 (2006)[DOI]
- Vahtsevanos K, "Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw", J Clin Oncol, 27, pp.5356~5362 (2009)[DOI]
- 최우성, "Medication-related osteonecrosis of the jaw: a preliminary retrospective study of 130 patients with multiple myeloma", Maxillofacial Plastic Reconstructive Surgery, 39(1), pp.1~7 (2017), 대한악안면성형재건외과학회[DOI]
- Choi SY, "Bone turnover and inflammatory markers of bisphosphonate-related osteonecrosis of the jaw in female osteoporosis patients", J Oral Maxillofac Surg Med Pathol, 25, pp.123~128 (2013)[DOI]
- Lesclous P, "Bisphosphonate-associated osteonecrosis of the jaw: a key role of inflammation?", Bone, 45, pp.843~852 (2009)[DOI]
- Coxon FP, "Visualizing mineral binding and uptake of bisphosphonate by osteoclasts and non-resorbing cells", Bone, 42, pp.848~860 (2008)[DOI]
- Boonyapakorn T, "Bisphosphonate-induced osteonecrosis of the jaws: prospective study of 80 patients with multiple myeloma and other malignancies", Oral Oncol, 44, pp.857~869 (2008)[DOI]
- Pautke C, "Fluorescence-guided bone resection in bisphosphonate-related osteonecrosis of the jaws: first clinical results of a prospective pilot study", J Oral Maxillofac Surg, 69, pp.84~91 (2011)[DOI]
- Carlson ER, "The role of surgical resection in the management of bisphosphonate-related osteonecrosis of the jaws", J Oral Maxillofac Surg, 67(5 Suppl), pp.85~95 (2009)