Risk Factors Influencing Medication-Related Osteonecrosis of the Jaws (MRONJ) Following Dental Extraction Among Osteoporotic Patients in Taiwan

Ling-Ying Wei; Yi-Wen Cheng; Wei-Yih Chiu; Sang-Heng Kok; Hao-Hong Chang; Shih-Jung Cheng; Jang-Jaer Lee

doi:10.1002/hed.28011

Risk Factors Influencing Medication-Related Osteonecrosis of the Jaws (MRONJ) Following Dental Extraction Among Osteoporotic Patients in Taiwan

Head Neck. 2024 Nov 29. doi: 10.1002/hed.28011. Online ahead of print.

Authors

Ling-Ying Wei^{1

2}, Yi-Wen Cheng¹, Wei-Yih Chiu³, Sang-Heng Kok^{1

4}, Hao-Hong Chang^{1

4}, Shih-Jung Cheng^{1

4}, Jang-Jaer Lee^{1

4}

Affiliations

¹ Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
³ Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.

PMID: 39611589
DOI: 10.1002/hed.28011

Abstract

Aim: Antiresorptive therapy (ART) is commonly used in osteoporotic patients to prevent bone loss. This retrospective cohort study aimed to identify the risk factors associated with medication-related osteonecrosis of the jaw (MRONJ) in osteoporotic patients receiving dental extraction during ART.

Materials and methods: Data were collected from 937 patients with 1067 dental extractions conducted between January 2003 and May 2022, including 519 patients on oral alendronate, 276 on denosumab, and 172 on zoledronate. Multivariate logistic regression analysis was employed to assess potential risk factors.

Results: Regression model analysis revealed older age (AOR 1.09 per year; 95% CI, 1.06-1.12) and drug treatment exceeding 24 months (AOR 2.07; 95% CI, 1.29-3.30) as significant risk factors. A drug interruption of 3 or more months prior to tooth extraction lowered MRONJ risk (AOR 0.11; 95% CI, 0.07-0.17). Stratified by drug type, denosumab users had significantly lower risk of MRONJ after extraction (AOR 0.14; 95% CI, 0.07-0.27) compared to those on other medications. Factors of drug duration ≥ 24 months, < 3 months of interruption, and posterior mandibular tooth extraction posed the highest synergistic MRONJ risk (AOR 80.29; 95% CI, 33.05-195.09).

Conclusion: Our results suggest an association between a three-month ART interruption prior to tooth extraction and reduced MRONJ risk, especially in long-term ART patients undergoing posterior mandibular extractions. However, these findings require validation through prospective randomized controlled trials.

Clinical relevance: Scientific Rationale for Study: The study fills crucial knowledge gaps regarding MRONJ risks in osteoporotic patients undergoing dental extraction during antiresorptive therapy (ART), providing a foundation for informed clinical decisions.

Principal findings: Noteworthy findings include elevated MRONJ risk with older age and prolonged ART, the protective effect of a 3-month ART interruption, and denosumab users showing significantly reduced postextraction MRONJ risk.

Practical implications: Implementing a 3-month ART interruption before dental extraction is recommended to reduce MRONJ occurrences.

Keywords: medication‐related osteonecrosis of the jaws; osteoporotic patients; risk factor; tooth extraction.