Characteristics of patients with osteonecrosis of the jaw with oral versus intravenous bisphosphonate treatment

Seung-Hun Lee,Min-Su Bae,So-Young Choi,Tae-Geon Kwon

doi:10.1186/s40902-021-00310-w

Abstract

PurposeThis retrospective study was aimed to evaluate the clinical characteristics and treatment outcomes in patients with osteonecrosis of the jaw who were receiving oral versus intravenous (IV) bisphosphonate (BP).Materials and methodsThis retrospective study enrolled subjects who had been diagnosed with medication-related osteonecrosis of the jaw (MRONJ) during the period from July 2010 to June 2014. Information regarding the following demographic and clinical characteristics was collected: demographic data, administration route and type of BP, duration of BP medication, primary disease, number of involved sites, location of the lesion, number of surgeries, outcome of treatments, and laboratory test. All the patients were divided into oral and IV BP groups; and the between-group differences were compared.ResultsTotal 278 patients were divided into two groups as per the route of BP administration. The proportion of oral BP-related MRONJ group were more dominant over IV BP group (oral BP, n = 251; IV BP, n = 27). In the IV BP group, the average dosing duration (31.4 months) was significantly shorter than that in the oral BP group (53.1 months) (P < 0.001). The average number of involved sites in the oral BP group (1.21 ± 0.48) was smaller than that in the IV BP group (1.63 ± 0.84) (P < 0.001). The average number of surgeries was higher in the IV BP group (1.65 ± 0.95) as compared to that in the oral BP group (0.98 ± 0.73) (P < 0.001). Outcome after the surgery for MRONJ after IV BP was poor than oral BP group.ConclusionIV administration of BP causes greater inhibition of bone remodeling and could lead more severe inflammation. Therefore, even if the duration of IV administration of BP is shorter than that of oral BP, the extent of the lesion could be more extensive. Therefore, the result suggests that the MRONJ after IV BP for cancer patients needs to be considered as different characteristics to oral BP group for osteoporosis patents.

Highlights

Bisphosphonates (BP) are widely used in the treatment of osteoporosis and other metabolic disease as well as malignant tumors
The proportion of oral BP-related medicationrelated osteonecrosis of the jaw (MRONJ) group were more dominant over IV BP group
Outcome after the surgery for MRONJ after IV BP was poor than oral BP group

Summary

Introduction

Bisphosphonates (BP) are widely used in the treatment of osteoporosis and other metabolic disease as well as malignant tumors. Oral BP are approved for the treatment of osteoporosis, osteopenia, and other rare bone disease including Paget disease and osteogenesis. Each category includes a subgroup of risk factors, such as dentoalveolar surgery, corticosteroid use, diabetes mellitus, type of BP, route of BP administration, and duration of medication. MRONJ tends to occur more frequently in patients on IV BP than in those on oral BP [4, 7, 8]. In patients with ONJ after IV BP, it had been shown that there was significant decrease in bone turn over marker [9,10,11]. It had been suggested that ONJ is usually less aggressive and is associated with better treatment response after oral BP administration than after IV BP [11]

Methods

Results

Conclusion