A Retrospective Analysis of Outcomes of Nonoperative Therapy for Medication-Related Osteonecrosis of the Jaw.

BACKGROUND

Limited research is available regarding the role of nonoperative therapy in managing medication-related osteonecrosis of the jaw (MRONJ) as it relates to progression or resolution of disease.

PURPOSE: The study purpose was to estimate the time to MRONJ stage improvement and risk for relapse among patients managed nonoperatively.

STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study included subjects diagnosed with MRONJ at Keio University Hospital between April 2012 and July 2024. Exclusion criteria included absence of a panoramic radiograph, prior operative therapy, or an observation period of less than 3 months.

PREDICTOR VARIABLE: The predictor variable was a set of heterogeneous factors including age, sex, disease stage at the initial visit, presence of diabetes, use of steroid, radiographic findings, primary disease, type of bone-modifying agent (BMA), and BMA holiday before improvement. Disease stage after the stage improvement and BMA holiday after the disease improvement were included as covariates for evaluating the risk of relapse.

MAIN OUTCOME VARIABLE: The main outcome variable was therapeutic response measured as the time between initial treatment and MRONJ stage improvement, which was defined as an improvement of at least one stage. The secondary outcome was relapse measured as the time between maximal therapeutic response measured by MRONJ stage and worsening of the MRONJ stage.

ANALYSES: The Fine-Gray subdistribution hazard model was used to estimate the cumulative incidence function (CIF) of outcomes, and Gray's test was used to compare CIF curves for relapse after stage improvement.

RESULTS

The sample was composed of 118 subjects with a mean age of 73.4 (±10.03), 54 (45.8%) were male, and the median interquartile range (IQR) duration of follow-up was 23 (11 to 32.5) months. During the study interval, 84 (71.2%) subjects achieved stage improvement, resulting in a 12-month CIF of 0.594. After achieving maximal therapeutic effect, 34 subjects (40.5%) experienced relapse. Incomplete healing after the stage improvement was associated with a higher risk of relapse (P = .0016), with a CIF of 0.661 at 36 months.

CONCLUSIONS AND RELEVANCE: More than half of the subjects experienced stage improvement within 12 months. Incomplete healing following initial intervention may increase the risk of relapse.