Highlighted review: Interventions for managing medication-related osteonecrosis of the jaw

Natalie H Beth-Tasdogan, Benjamin Mayer, Heba Hussein, Oliver Zolk

Plain language summary: Interventions for managing medication-related osteonecrosis (severe bone damage) of the jaw

Review question
What are the effects of different interventions to either prevent or treat medication-related osteonecrosis of the jaw compared with each other or compared with no treatment or an inactive intervention ('placebo')?

Background
Medication-related osteonecrosis of the jaw (MRONJ) is severe bone damage in the jaw bone that occurs in some people as an adverse reaction to certain medicines commonly used in the treatment of cancer and osteoporosis (a disease that makes bones fragile). It is a painful condition that can be difficult to treat. MRONJ occurs rarely in people taking some medicines for osteoporosis. However, in people receiving these drugs at higher doses for cancer-related conditions, the risk of MRONJ may be higher and has been reported to occur in up to 5 in 100 individuals. It is essential to obtain better treatments for people who have MRONJ. It is also important to identify effective preventive measures to reduce the risk of MRONJ.

Study characteristics
Working with Cochrane Oral Health, we searched for studies that had been published up to November 2016. We found three studies that focused on the prevention of MRONJ and two studies that tested treatments for MRONJ. The studies involved 1218 adults, with the smallest study having 40 participants and the largest study having 700 participants. Most study participants were women, but one study was of men with prostate cancer receiving bisphosphonate infusions (given by drip into a vein). All studies included only participants treated with bisphosphonates (used to support treatment and reduce risk of fracture and bone pain), although several other drugs are also known to induce MRONJ.

Key results
One study provided low-quality evidence that dental examinations at three-month intervals and preventive treatments (antibiotics before dental extractions and the use of techniques for wound closure that avoid exposure and contamination of bone) are more effective than standard care for reducing the number of cases with MRONJ in a group of people receiving intravenous bisphosphonates for cancer-related conditions. In the experimental group (which received preventive care consisting of antibiotics and specific wound closure), fewer people developed MRONJ (2 participants per 100 who underwent close monitoring) compared with the control group (23 participants per 100 who had standard care).

There was insufficient evidence to conclude that the use of the other interventions investigated would reduce the risk of MRONJ or would improve healing of MRONJ.

Quality of evidence
The quality of evidence was low or very low. This was due to limitations in how the studies were designed and run. For example, some participants changed groups during the study, some participants did not finish the study, and the outcomes were measured at different follow-up times.

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Citation: Beth-Tasdogan NH, Mayer B, Hussein H, Zolk O. Interventions for managing medication-related osteonecrosis of the jaw. Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No.: CD012432. DOI: 10.1002/14651858.CD012432.pub2.