Incidence and treatment of MR-ONJ in a cohort of oncological patients.

Antiresorptive and antiangiogenic therapy, as well as target therapy agents (such as drugs for immunotherapy, immunomodulators, enzyme or protein inhibitors), are widely administered in several life-threatening oncological and hematological diseases. Medication-related osteonecrosis of jaws (MR-ONJ) is an adverse effect which incidence is strongly related to primary disease history, therapy management and duration, systemic co-morbidities treatments, dental and oral health control. A previously reported case series described a 10-year (2007-2016) single-center raw incidence of 47 MR-ONJ cases in a cohort of 1663 patients treated with antiresorptive drugs (2.8%). The significant positive effect of a dental and oral health prevention protocol was appreciated by splitting the cohort into two timeframes, 2007-2010 and 2011-2016. During the first period, dental evaluation and treatment were not implemented and MR-ONJ incidence was 4.9%; in the second one, the incidence dropped (1.9%), suggesting the value of the applied protocol. Between February 2020 and February 2021, 184 onco-hematological new patients were referred for comprehensive dental, oral health evaluation and treatment. Including subjects already in follow-up, overall 313 patients were in charge. In 12 months, MR-ONJ occurred in 5 cases (incidence 1.6%). Altogether, 11 MR-ONJ cases were treated in the considered timeframe, of which 6 were previously diagnosed. Following staging, treatment options ranged from conservative to surgical therapy, depending on extension, drug history, primary disease prognosis, and patient feasibility.