J Korean Assoc Oral Maxillofac Surg.  2023 Apr;49(2):68-74. 10.5125/jkaoms.2023.49.2.68.

The effect of drug holiday before tooth extraction on the development of medication-related osteonecrosis of the jaw in cancer patients receiving intravenous bisphosphonates

• Karaca
• Topaloğlu-Yasan G
• Adiloğlu S
• Usman E

• KMID: 2542212
• DOI: http://doi.org/10.5125/jkaoms.2023.49.2.68

Abstract

Objectives
Drug holidays are suggested to reduce the formation of osteonecrosis in patients under intravenous (IV) bisphosphonates (BPs) therapy. The objectives of this study are to evaluate the incidence of medication-related osteonecrosis of the jaw (MRONJ) following tooth extraction in cancer patients using IV BP, and to assess the effect of drug holiday on the development of MRONJ.
Patients and Methods
A manuel search of the patient folders of Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University was undertaken to identify cancer patients who used IV BPs and had at least one tooth extraction between 2012 and 2022. Patents’ age, sex, systemic condition, the type of BP used, duration of BP used, number of tooth extraction, duration of drug holiday, localization of tooth extraction and incidence of MRONJ were recorded.
Results
One hundred nine teeth were removed from 57 jaws in 51 patients. All tooth extractions were performed under perioperative antibiotic prophylaxis and with primary wound closure. The incidence of MRONJ was 5.3%. Stage 1 MRONJ developed in 3 patients (only one had a drug holiday). The median duration of drug holiday was 2 months. No significant difference between the patients with and without a drug holiday and MRONJ development was found (P=0.315). The mean age of patients developed MRONJ was 40.33±8.08 years. A statistically significant difference was found between age and MRONJ development (P=0.002).
Conclusion
The effect of a short-term drug holiday on the development of MRONJ may be limited because BPs remain in bone tissue for a long time. Drug holidays should be applied with the approval of an oncologist with other preventive measurements.

Keyword

Bisphosphonate; Bisphosphonate-associated osteonecrosis of the jaw; Cessation of treatment; Osteonecrosis; Tooth extraction

Figure

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  Fig. 1 The distribution of the diseases shows that the most common reason resulted in intravenous bisphosphonate use was breast CA. (CA: cancer, SCC: squamous cell carcinoma)

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  Fig. 2 A. The preoperative panoramic radiograph shows the extracted third molar in the right maxilla (arrow). B. The exposed necrotic bone was determined on the buccal aspect 1 year after tooth extraction (arrow). C. Surgical treatment was performed to remove the necrotic bone and bony edges.

Reference

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