Effect of Statins on Patients With Osteoradionecrosis of the Jaw

Abstract

BackgroundOsteoradionecrosis of the jaw (ORN) is a refractory late complication of radiation therapy. Radiation-induced fibrosis (RIF) is the most likely mechanism for developing ORN, and statins are effective against RIF. However, no reports have indicated the direct effectiveness of statins in treating ORN. PurposeThis study aimed to measure the association between statin exposure and ORN disease resolution. Study design, setting, sampleThis retrospective cohort study included patients with ORN diagnosed between January 2008 and December 2020 at the Hospital’s Department of Oral and Maxillofacial Surgery. Patients who were immunocompromised or followed up for < 6 months were excluded. Predictor variableThe predictor variable was statin exposure, which was defined as the use of statins for dyslipidemia by coincidence. Main outcome variableThe main outcome variable was ORN disease progression status (good prognosis). Patients who showed full recovery and improvement were included in the good prognosis group, and those who showed invariance and deterioration were included in the poor prognosis group. CovariatesWe analyzed the clinicodemographic including the age of onset, sex, history of smoking, alcohol consumption, history of chemotherapy, tumor site, association with dental treatment, location (maxilla or mandible), the time to ORN onset from radiation therapy, and stage of ORN, and treatment characteristics including hyperbaric oxygen therapy, long-term macrolide administration, and sequestrectomy. AnalysesWe analyzed the association between statin exposure/covariates and time to ORN improvement using bivariate and multivariate Cox regression. The significance level was set at p = 0.05. ResultsWe analyzed 102 patients, and the improvement rate was 32.4%. The favorable prognostic factors were statin exposure (adjusted hazard ratio [HR], 3.71; 95% confidence interval [CI], 1.62–8.50; p = 0.002), onset in the maxilla (HR, 2.15; 95% CI, 1.02–4.55; p = 0.045), and stage 1 of ORN (HR, 2.65; 95% CI, 1.20–5.83; p = 0.016). Conclusions and RelevanceIn this study, statin exposure, onset in the maxilla, and stage 1 of Lyons’s classification were favorable prognostic factors for ORN. Statins may be a novel and effective treatment for ORN.