Bisphosphonate-related Osteonecrosis of The Jaw : Is the Medication Duration Related to Advanced Disease Stage?

Background Osteonecrosis of the jaw (ONJ) is a serious adverse effect of therapy with bisphosphonates (BP) and other antiresorptive agents. The aim of the study was to report 13 patient cases of bisphosphonates-related osteonecrosis of the jaw (BRONJ) at Kaohsiung Veterans General Hospital (VGHKS), Taiwan, and their medical history and disease outcomes. Materials and Methods Thirteen symptomatic patients with BRONJ were reviewed between 1985 and 2021 at VGHKS. We included symptomatic patients who were in advanced BRONJ stages 2 and 3: 4 multiple myeloma, 3 bone metastatic breast cancer, and 6 advanced osteoporosis patients. Results Seven patients were American Association of Oral and Maxillofacial Surgeons’ medication-related osteonecrosis of the jaw stage 3, and 6 were stage 2. The average antiresorptive medication duration was 25.83 ± 31.45 months in BRONJ stage 2 patients and 53.71 ± 31.25 months in BRONJ stage 3 patients, respectively. No correlation was found between the antiresorptive agent duration and BRONJ stage ( P = 0.098; Mann-Whitney U test) among cancer ( P = 0.157; Mann-Whitney U test) and osteoporosis patients ( P = 0.184; Mann-Whitney U test). Conclusions Most of them died of terminal stage cancer disease or complications of being bedridden. The correlation between the duration of antiresorptive agents and BRONJ stage needs larger patient data to confirm the result.