Suad Aljohani1, Robert Gaudin2, Julian Weiser3, Matthias Tröltzsch4, Michael Ehrenfeld4, Gabriele Kaeppler4, Ralf Smeets3, Sven Otto4. 1. Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität, Head: Prof. Dr. Med. Dr. Med. Dent. Michael Ehrenfeld, Lindwurmstrasse 2a, 80337, Munich, Germany; Department of Oral Basic & Clinical Sciences, King Abdulaziz University, Al Sulaimaniyah, 21589, Jeddah, Saudi Arabia. Electronic address: suad.aljohani@campus.lmu.de. 2. Department of Oral and Maxillofacial Surgery, Charité University, Aßmannshauser Str. 4-6, 14197 Berlin, Germany. 3. Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany. 4. Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität, Head: Prof. Dr. Med. Dr. Med. Dent. Michael Ehrenfeld, Lindwurmstrasse 2a, 80337, Munich, Germany.
Abstract
PURPOSE: Osteonecrosis of the jaw has been recently reported in patients receiving denosumab for the treatment of metastatic bone disease and osteoporosis. It is essential to investigate this disease as a new osteonecrosis entity in order to recognize its optimal management strategies. MATERIALS AND METHODS: A total of 63 cases of denosumab-related osteonecrosis of the jaw (DRONJ) diagnosed at two clinical centres were retrospectively reviewed. Demographics, comorbidities, antiresorptive medication use, local preceding event, location, DRONJ stage, treatment and treatment outcomes were analyzed. RESULTS: In all, 69 MRONJ lesions in 63 patients were diagnosed. The mean patient age was 70 ± 9 years. Denosumab was the only received antiresorptive medication in 50.8% of the patients. Discontinuation of denosumab prior to treatment was recorded for 66.7% of the patients, with a mean period of 6 ± 3.4 months. Stage 2 was the most common stage of the disease (71%). The lesions were predominantly located in the mandible (63.5%). The most common preceding local event was extraction (55.6%). Surgical treatment was performed in 95.7% of the cases, while purely conservative treatment was performed in 4.3%. DRONJ healed after surgical treatment in 71.7% of the treated lesions. Complete mucosal healing was achieved in 77.2% of the lesions treated with fluorescence-guided surgery (17/22). Clinical characteristics and treatment outcomes were not significantly different between patients with and without previous intake of bisphosphonates. CONCLUSION: DRONJ is more prevalent at extraction and local infection sites in cancer patients. Within the limitation of this study, surgical treatment, particularly fluorescence-guided surgery, appears to be effective for the management of DRONJ. The prior use of bisphosphonates does not seem to affect severity nor the treatment success rate of DRONJ.
PURPOSE:Osteonecrosis of the jaw has been recently reported in patients receiving denosumab for the treatment of metastatic bone disease and osteoporosis. It is essential to investigate this disease as a new osteonecrosis entity in order to recognize its optimal management strategies. MATERIALS AND METHODS: A total of 63 cases of denosumab-related osteonecrosis of the jaw (DRONJ) diagnosed at two clinical centres were retrospectively reviewed. Demographics, comorbidities, antiresorptive medication use, local preceding event, location, DRONJ stage, treatment and treatment outcomes were analyzed. RESULTS: In all, 69 MRONJ lesions in 63 patients were diagnosed. The mean patient age was 70 ± 9 years. Denosumab was the only received antiresorptive medication in 50.8% of the patients. Discontinuation of denosumab prior to treatment was recorded for 66.7% of the patients, with a mean period of 6 ± 3.4 months. Stage 2 was the most common stage of the disease (71%). The lesions were predominantly located in the mandible (63.5%). The most common preceding local event was extraction (55.6%). Surgical treatment was performed in 95.7% of the cases, while purely conservative treatment was performed in 4.3%. DRONJ healed after surgical treatment in 71.7% of the treated lesions. Complete mucosal healing was achieved in 77.2% of the lesions treated with fluorescence-guided surgery (17/22). Clinical characteristics and treatment outcomes were not significantly different between patients with and without previous intake of bisphosphonates. CONCLUSION: DRONJ is more prevalent at extraction and local infection sites in cancerpatients. Within the limitation of this study, surgical treatment, particularly fluorescence-guided surgery, appears to be effective for the management of DRONJ. The prior use of bisphosphonates does not seem to affect severity nor the treatment success rate of DRONJ.
Authors: J G Messer; E J Castillo; A M Abraham; J M Jiron; R Israel; J F Yarrow; S Thomas; M C Reynolds; R D Wnek; M Jorgensen; N Wanionok; C Van Poznak; I Bhattacharyya; D B Kimmel; J I Aguirre Journal: Bone Date: 2019-11-07 Impact factor: 4.398
Authors: T Hasegawa; N Ueda; S I Yamada; S Kato; E Iwata; S Hayashida; Y Kojima; M Shinohara; I Tojo; H Nakahara; T Yamaguchi; T Kirita; H Kurita; Y Shibuya; S Soutome; M Akashi Journal: Osteoporos Int Date: 2021-05-17 Impact factor: 4.507
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Authors: Sven Otto; Suad Aljohani; Riham Fliefel; Sara Ecke; Oliver Ristow; Egon Burian; Matthias Troeltzsch; Christoph Pautke; Michael Ehrenfeld Journal: Medicina (Kaunas) Date: 2021-05-09 Impact factor: 2.430