“What is the Incidence of MRONJ with Zoledronate vs. Denosumab in Assocition with Tooth Extrction?”

7.22.24 Quick Review #186 - #pathology #oralpathology #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental #MRONJ #osteonecrosis The incidence of osteonecrosis of the jaw (ONJ) in patients undergoing treatment with zoledronate and denosumab, particularly in relation to tooth extractions, has been extensively studied. 1. Zoledronate: Zoledronic acid, a bisphosphonate, has been associated with ONJ, with an incidence rate that increases over time. Studies indicate that the risk of ONJ with zoledronic acid is about 1% after one year, 2% after two years, and up to 3% after three years of treatment. This risk varies depending on the type of cancer being treated and the patient’s dental health status. 2. Denosumab: Denosumab, a RANKL inhibitor, has also been linked to ONJ. The incidence rates for ONJ with denosumab are similar to those seen with zoledronate, particularly when denosumab is used for metastatic cancer patients. One study highlighted that tooth extractions are a significant risk factor for developing ONJ in patients treated with denosumab, with up to 66% of ONJ cases associated with dental extractions . 3. Comparative Incidence: A multi-institutional retrospective cohort study found that the risk of developing ONJ was comparable between patients treated with zoledronate and those treated with denosumab. The study emphasized that both medications pose a similar risk for ONJ development, particularly following invasive dental procedures such as tooth extractions . 4. Prevention and Management: Preventive measures are crucial for patients receiving these treatments. Recommendations include dental assessments before starting therapy, maintaining good oral hygiene, and avoiding invasive dental procedures during treatment whenever possible. When dental extractions are necessary, implementing preventive protocols and close monitoring can help mitigate the risk of ONJ . References: 1. Marciano, A., Ieni, A., Mauceri, R., & Oteri, G. (2021). Radiologic appearance of focal MRONJ lesion in left mandible. In CD34 and CD105 Microvessels in Resected Bone Specimen May Implicate Wound Healing in MRONJ. ResearchGate. 2. Nicolatou-Galitis, O., Schiødt, M., Mendes, R. A., Ripamonti, C., Hope, S., Drudge-Coates, L., … & Campisi, G. (2019). Medication-related osteonecrosis of the jaw: Definition and best practice for prevention, diagnosis, and treatment. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 127(2), 117-135. https://lnkd.in/e73HX5aX 3. McClung, M. R., Wagman, R. B., Miller, P. D., Wang, A., & Lewiecki, E. M. (2017). Observations following discontinuation of long-term denosumab therapy. Osteoporosis International, 28(5), 1723-1732. https://lnkd.in/er_rr6h2 4. ChatGPT. 2024. - #podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentistry #oralsurgery #dental #viral #dentalschool #dentalstudent #omfs #surgeon #doctorlife #dentistlife #residency #oralsurgeon #dentist #doctorgallagher