Patients' osteometabolic control improves the management of medication-related osteonecrosis of the jaw.

Publication date: Available online 14 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Gianluca Colapinto, Raffaele Volpi, Giovanni Forino, Vito Tricarico, Michele De Benedittis, Roberto Cortelazzi, Tiziano Testori, Massimo Del Fabbro
Objectives.Osteonecrosis of the jaws (ONJ) represents a concern for patients taking antiresorptive drugs. The aim of this study was to test the hypothesis that preoperative individualized pharmacological control of the patient's osteometabolic profile could lead to predictable healing of the surgically treated region and minimize the incidence of complications.Study Design.This prospective study included 95 test patients (53 with osteoporosis and 42 with cancer), and 94 control patients (49 with osteoporosis and 45 with cancer) who were on antiresorptive therapy and were candidates for ONJ treatment. Test patients underwent osteometabolic profile assessment and personalized pharmacological supplementation before intervention. In all cases, a drug holiday was scheduled for three months before and at least three months after the intervention. Healing was assessed clinically and radiographically.Results.In the test group, after a mean follow-up of 28.2±7.8 months only one ONJ recurrence occurred, and was successfully resolved after resuming the pharmacological protocol. Five patients reported minor complications. Overall, 100% treatment success was observed. In the control group, after 28.1±4.9 months follow-up, 6 fistulae, 19 abscesses and 34 dehiscences occurred. In total, 62.8% of patients in the control group had complications or adverse events. The difference between the two groups was highly significant.Conclusions.A strict osteometabolic control should be routinely done in the management of patients taking antiresorptive drugs.



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