Clinical risk factors for severity and prognosis of antiresorptive agent-related osteonecrosis of the jaw: a retrospective observational study

• Published in: Journal of bone and mineral metabolism Vol. 40; no. 6; pp. 1014 - 1020
• Main Authors: Nashi, Masanori, Hirai, Toshinori, Iwamoto, Takuya, Takenobu, Toshihiko
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.11.2022; Springer Nature B.V
• Subjects: C-reactive protein; Jaw; Medicine; Medicine & Public Health; Metabolic Diseases; Necrosis; Original Article; Orthopedics; Osteonecrosis; Patients; Regression analysis; Risk factors; Vitamin D; Hypoalbuminemia; C-reactive protein; Antiresorptive agent-related osteonecrosis of the jaw; Older; Cancer
• ISSN: 0914-8779; 1435-5604
• DOI: 10.1007/s00774-022-01367-x

Introduction The incidence of antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is rare, and its management has not yet been established. This study aimed to investigate the predictors for advanced stage and healing of ARONJ to establish an appropriate treatment strategy. Materials and methods We retrospectively analyzed patients diagnosed with ARONJ at Kobe City Medical Center General Hospital between April 2014 and March 2020. Outcomes were defined as stage ≥ 2 ARONJ (primary) and healing of ARONJ (secondary). Multivariate logistic regression analysis was used to detect factors associated with the outcomes, and odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results This study included 143 patients (stage ≥ 2 ARONJ, 51%; healing of ARONJ, 60%). Multivariate logistic regression analysis revealed that advanced age (per year) (OR 1.037; 95% CI 1.003–1.072; p  = 0.028) and serum albumin (per g/dL) (OR 0.430; 95% CI 0.213–0.869; p  = 0.018) were significantly associated with stage ≥ 2 ARONJ. Furthermore, multivariate logistic regression analysis revealed that cancer (yes) (OR 0.099; 95% CI 0.029–0.339; p  < 0.001), conservative surgical treatment (yes) (OR 15.42; 95% CI 5.657–42.0; p  < 0.001), C-reactive protein (per mg/dL) (OR 0.599; 95% CI 0.415–0.864; p  < 0.001), and vitamin D analog (yes) (OR 0.167; 95% CI 0.034–0.827; p  = 0.028) were factors associated with healing. Conclusion Our findings suggest that age and hypoalbuminemia are associated with the severity of ARONJ, and cancer, high inflammation, and vitamin D analog may impair healing. In contrast, conservative surgical treatment can overcome the poor treatment outcomes associated with ARONJ.