Search Results (5)

Background/Objectives: Denosumab-related osteonecrosis of the jaw (DRONJ) is a serious complication in patients receiving long-term antiresorptive therapy for bone metastases from prostate cancer. While established risk factors include invasive dental procedures and poor oral health, the role of body composition, with a particular focus on sarcopenia and inflammatory biomarkers, remains unclear. This study aims to evaluate the association between skeletal muscle mass, fat distribution, and systemic inflammatory biomarkers with DRONJ risk in Asian prostate cancer patients with bone metastases. Methods: This retrospective study reviewed 64 patients who received denosumab between 2014 and 2023. Baseline CT scans were used to measure total psoas muscle index (TPI), visceral fat area (VFA), subcutaneous fat area (SFA), and body mass index (BMI). Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated from blood counts. Group comparisons used the Wilcoxon rank-sum or chi-squared test, and correlations were assessed using Spearman’s coefficient. Results: Twelve patients (18.8%) developed DRONJ, with a mean onset time of 20.3 months. The prevalence of sarcopenia was significantly higher in the DRONJ group compared to the non-DRONJ group (p = 0.0331). VFA, SFA, BMI, diabetes, and visceral obesity were not significant predictors. NLR, but not PLR, showed a significant negative correlation with TPI (ρ = −0.2487, p = 0.0475), but no direct association with DRONJ, suggesting an indirect effect via sarcopenia. Conclusions: Sarcopenia may be an independent risk factor for DRONJ. Inflammatory biomarkers, particularly NLR, may contribute indirectly through reduced muscle mass. Body composition assessment may improve DRONJ risk stratification. Full article

Aims: Medication-related osteonecrosis of the jaw (MRONJ) is a drug-related adverse reaction characterized by bone destruction and necrosis in the jaw. This case series aims to evaluate the treatment approaches and outcomes in MRONJ patients. Materials and methods: The retrospective study was conducted at the Dental Unit of the University of Bari, Italy. Patients with MRONJ were treated and followed up for 60 months. The treatment approach involved piezosurgery and concentrated growth factor (CGF). Six clinical cases from this group are described in detail. Results: None of the patients showed recurrence of necrotic MRONJ lesions during the follow-up period. The surgical interventions, including bone resections and the application of CGF, resulted in successful mucosal healing and the prevention of disease progression. Conclusions: This study highlights the complexity of managing MRONJ and the importance of a multidisciplinary approach. Conservative treatment options and minimally invasive surgery have shown efficacy in controlling symptoms and improving patients’ quality of life. However, the optimal treatment approach remains a challenge, and further studies are needed to evaluate alternative therapies and resective surgery. A comprehensive preoperative evaluation and collaboration among dental, endocrinology, and oncology specialists are crucial for personalized and multidisciplinary management. Ongoing research efforts are necessary to explore new therapeutic modalities and improve our understanding of MRONJ management, providing better support to patients dealing with this complex condition. Full article

MRONJ is a serious drug-related side effect that is most common in people using antiresorptive and/or angiogenic medications. Therapy options for this condition include conservative treatments, surgical procedures with varied degrees of invasiveness, and adjuvant therapies. The aim of the present study is to identify the most successful and promising therapy alternatives available to clinicians. PubMed, Cochrane, Scopus, Web of Science, and Embase were searched for works on our topic published between 8 January 2006 and 8 January 2023. The search was restricted to randomized clinical trials, retrospective studies, clinical studies, and case series involving human subjects with at least five cases and no age restriction on participants. A total of 2657 was found. After the selection process, the review included 32 publications for qualitative analysis. Although conservative treatments (pharmacological, laser, and minimally invasive surgery) are effective in the early stages of MRONJs or as a supplement to traditional surgical resection therapy, most studies emphasize the importance of surgical treatment for the resolution or downstaging of advanced lesions. Fluorescence-guided surgery, PRP, PRF, CGF, piezosurgery, VEGF, hyaluronic acid, and ozone therapy all show significant potential for improving treatment outcomes. Full article

This single-center retrospective observational study aimed to identify risk factors for developing denosumab-related osteonecrosis of the jaw (DRONJ) in stage IV solid cancer patients with bone metastases. In total, 123 consecutive patients who had received 120 mg of denosumab every 4 weeks at least twice between July 2014 and October 2018 were included. We surveyed their demographics, medical history, blood test, underlying disease, and intraoral findings. Fourteen patients (11.4%) developed DRONJ within a mean denosumab administration period of 4 months (range: 2–52 months). Univariate analyses showed a statistically significant correlation between DRONJ and hormone therapy, chemotherapy/molecular target drug, apical periodontitis, periodontal disease, sex and body mass index. Multivariate analysis showed a statistically significant correlation between DRONJ and hormone therapy (odds ratio [OR], 22.07; 95% confidence interval [CI], 2.86–170.24), chemotherapy and/or molecular targeted therapy (OR, 18.61; 95% CI, 2.54–136.27), and apical periodontitis (OR, 22.75; 95% CI, 3.20–161.73). These findings imply that collaborative oral examinations by oral specialists may reduce the risk of development of DRONJ in patients treated with denosumab for bone metastases from solid cancers. Full article

Medication-related osteonecrosis of the jaw (MRONJ) was first reported more than a decade ago. Since then, numerous cases have been diagnosed. Currently, there are three groups of drugs related to MRONJ: bisphosphonates, denosumab and anti-angiogenic drugs. As MRONJ can lead to debilitating clinical sequels and limited effective treatment options are available, much research has been done in understanding its pathophysiology. Until now, the exact pathogenesis of MRONJ has not been fully elucidated. While history of invasive dental procedures or local trauma may be present, some cases occur spontaneously without any preceding factors. This review aims to examine and discuss the three main hypotheses for the pathogenesis of MRONJ, namely suppressed bone turnover, cellular toxicity and infection. Full article