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Publications

Journal Article Epublish

PubMed: 41943819 DOI: 10.1093/jbmrpl/ziag038

The therapeutic window: timing dentoalveolar surgery to minimize MRONJ risk in denosumab-treated osteoporotic patients.

JBMR Plus 10(5):ziag038

Authors: Daya Masri, Eli Rosenfeld, Shaked Adut, Gavriel Chaushu, Gloria Tsvetov, Gal Avishai, Omar Ghanaiem, Ehud Jonas, Ayelet Zlotogorski-Hurvitz, Daniel Muchnik

Affiliations

  • Department of Oral and Maxillofacial Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva 49414, Israel.
  • Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
  • Department of Oral and Maxillofacial Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva 49414, Israel. Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
  • Department of Endocrinology, Diabetes and Metabolism, Rabin Medical Center-Beilinson Hospital, Petach Tikva 49414, Israel.
  • Oral Medicine Unit, Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv 69978, Israel.
  • Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel.

Abstract

Osteoporosis patients treated with denosumab (Dmab) remain at risk for medication-related osteonecrosis of the jaw (MRONJ), particularly after dentoalveolar surgery. Optimizing surgical timing may reduce this risk while avoiding complications related to prolonged drug interruption. This retrospective cohort study evaluated 258 osteoporotic patients receiving Dmab and examined both patient-level data and intervention-level data from 91 patients who underwent 185 dentoalveolar procedures. Multivariable logistic regression and generalized estimating equations (GEE) were applied to identify factors associated with MRONJ development. Medication-related osteonecrosis of the jaw occurred in 5.43% of the total cohort. All MRONJ cases at the intervention level were observed when dentoalveolar procedures were performed within 3 mo of a Dmab injection. A longer interval between the last Dmab dose and dentoalveolar intervention demonstrated a strong protective effect against MRONJ (OR 0.35, p = .0089). In addition, prolonged previous antiresorptive drug intake was identified as a significant independent risk factor at the patient level. No specific type of dentoalveolar procedure showed a statistically significant association with MRONJ development. These findings confirm that surgical timing is a critical determinant of MRONJ risk in Dmab-treated osteoporotic patients. Avoiding dentoalveolar interventions during the early post-injection period, particularly within the first 3 mo, may substantially reduce risk. A delay of at least 4 mo after the last Dmab administration appears to be a clinically important preventative strategy, balancing MRONJ avoidance with the need to minimize fracture risk resulting from prolonged discontinuation of therapy. Additional prospective studies are warranted to refine surgical timing recommendations and guide individualized patient care.

MeSH

Injections, Pharmaceutical Preparations, Denosumab, Osteoporosis, Therapeutics, Osteonecrosis