Prevalence, initiating factor and treatment outcome of medication-related osteonecrosis of the jaw - a four year prospective study

Publication date: Available online 31 August 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Fredrik Hallmer, Gunilla Andersson, Bengt Götrick, Gunnar Warfvinge, Jonas Anderud, Tore Bjørnland

ABSTRACT

Objectives

Prevalence of MRONJ is reported with a wide range and a standard therapy has not yet been established. The aim was to analyse the prevalence and initiating factors of MRONJ and the outcome of surgical therapy.

Study design

In a prospective cohort study, all patients diagnosed with MRONJ in the region of Skåne were included. Predictor variables (co-morbidity, site, stage, gender) and initiating factors (tooth extraction, periodontitis) were recorded. Surgical treatment was sequestrectomy or block resection and the outcome variable was healing after 2 months. To estimate the prevalence, data on the use of bisphosphonate and denosumab were used.

Results

Fifty-five patients with MRONJ were identified. The prevalence of MRONJ for patients on oral bisphosphonates was 0.043%, on intravenous bisphosphonates 1.03% and on high dose denosumab 3.64%. Periodontal disease preceded development of MRONJ in 41 patients. Fifty patients were treated surgically and followed up for at least 2 months. Lesions progressed to remission or healing in 80.0% of patients treated with sequestrectomy and in 92.5% of patients treated with block resection.

Conclusion

The prevalence of MRONJ in Sweden is low. Periodontitis is the most common initiating factor. The treatment outcome of MRONJ demonstrates healing in most patients treated surgically.

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