Objectives
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse effect of antiresorptive and/or antiangiogenic agents. The standard treatment for MRONJ is conservative treatment and surgical approaches; however, its application remains controversial. This study aimed to identify the risk factors for poor prognosis and to help determine appropriate management.
Materials and Methods
We retrospectively investigated factors associated with the prognosis of MRONJ in 119 patients who received treatment between October 2010 and July 2020 at our department. Relevant clinical data were obtained for all the patients. In computed tomography images, osteosclerosis, osteolysis, cortical perforation (buccal or lingual), periosteal reaction, and sequestration were observed. Statistical analyses were performed using SPSS version 22.0 (IBM Corp., Armonk, NY). The association of each variable with MRONJ was analyzed using the Mann–Whitney U nonparametric test for ordinal variables and Fisher's exact test or chi-square test for categorical variables. Statistical significance was set at p< 0.05. The remaining variables were introduced into a Cox proportional hazards model.
Results
Patients with MRONJ included 26 males and 93 females, and their mean age was 76.2±10.6 (range, 48–97) years. Univariate analysis revealed that age, higher MRONJ stages, onset at mandible, malignant disease, nerve paralysis, orocutaneous fistula, trismus, treatment method, lingual cortical perforation, osteolysis, periosteal reaction, and non-sequestration as risk factors for poor prognosis. Multivariate analyses showed statistically significant associations between poor prognosis in patients with MRONJ and conservative treatment alone (hazard ratio [HR] 1.89), osteolysis (HR 4.67), and the absence of sequestration (HR 5.33).
Conclusions
Conservative treatment alone without clear objectives should be avoided, and osteolytic change could be the criteria for surgical intervention. As the boundary between the lesion and vital bone is indistinct, we recommend extensive surgery in cases which sequestration is unpredictable.