Clinical features of metastatic bone disease and risk of skeletal morbidity.

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Abstract

[Indexed for MEDLINE] 8. J Clin Endocrinol Metab. 2022 Apr 19;107(5):1441-1460. doi: 10.1210/clinem/dgab888. Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organized by the ECTS. Anastasilakis AD(1), Pepe J(2), Napoli N(3), Palermo A(3), Magopoulos C(4), Khan AA(5), Zillikens MC(6), Body JJ(7). Author information: (1)Department of Endocrinology, 424 General Military Hospital, 564 29 N Efkarpia Thessaloniki, Greece. (2)Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, "Sapienza" University of Rome, 00185 Rome, Italy. (3)Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy. (4)Department of Oral and Maxillofacial Surgery, 424 General Military Hospital, 56429 Thessaloniki, Greece. (5)Division of Endocrinology and Metabolism and Geriatrics, McMaster University, L8N3Z5 Hamilton, Ontario, Canada. (6)Bone Center, Department of Internal Medicine, Erasmus MC , 2040 Rotterdam, the Netherlands. (7)Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium. Comment in J Clin Endocrinol Metab. 2022 May 17;107(6):e2646. doi: 10.1210/clinem/dgac109. J Clin Endocrinol Metab. 2022 May 17;107(6):e2651-e2652. doi: 10.1210/clinem/dgac111. CONTEXT: Antiresorptive therapy significantly reduces fracture risk in patients with benign bone disease and skeletal-related events (SREs) in patients with bone metastases (BM). Osteonecrosis of the jaw (ONJ) is a rare but severe condition manifested as necrotic bone lesion or lesions of the jaws. ONJ has been linked to the use of potent antiresorptive agents, termed medication-related ONJ (MRONJ). OBJECTIVE: We aimed to identify the differences various aspects of MRONJ among distinct patient categories and provide recommendations on how to mitigate the risk and optimally manage MRONJ in each of them. METHODS: A working group of the European Calcified Tissue Society (ECTS) and 2 experts performed an updated detailed review of existing literature on MRONJ incidence, characteristics, and treatment applied in bone diseases with variable severity of skeletal insult, ranging from osteoporosis to prevention of cancer treatment-induced bone loss and SREs in cancer patients with BM. RESULTS: The risk for MRONJ is much higher in patients with advanced malignancies compared to those with benign bone diseases because of the higher doses and more frequent administration of antiresorptive agents in individuals with compromised general health, along with coadministration of other medications that predispose to MRONJ. The overall risk for MRONJ is considerably lower than the benefits in all categories of patients. CONCLUSION: The risk for MRONJ largely depends on the underlying bone disease and the relevant antiresorptive regimen applied. Physicians and dentists should keep in mind that the benefits of antiresorptive therapy far outweigh the risk for MRONJ development. © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. DOI: 10.1210/clinem/dgab888 PMCID: PMC9016445