Medication-related osteonecrosis of the jaw: incidence and risk factors in multiple myeloma patients undergoing pre-autologous stem cell transplant dental extractions.

PURPOSE: The purpose of this retrospective study was to investigate the incidence of MRONJ and its related risk factors in multiple myeloma (MM) patients undergoing dental extractions prior to autologous stem cell transplantation (ASCT).

METHODS

This retrospective study evaluated patients treated January 1, 2011, to January 1, 2022. Medical and dental records of 1547 patients referred to the Dental Oncology Clinic at Princess Margaret Cancer Centre were reviewed, with 320 patients meeting the eligibility criteria and included in the analysis.

RESULTS

Among 320 patients, patients had on average 3 teeth removed prior to ASCT and 13 (4.1%) developed MRONJ. Periodontal disease was the most common reason for dental extraction among MRONJ cases. Patients prescribed zoledronic acid alone were nearly 5 times more likely to develop MRONJ than patients treated with pamidronate alone, with the highest risk observed in patients who were prescribed pamidronate and later changed to zoledronic acid. Even a single dose of bisphosphonate was sufficient to cause MRONJ following dental extraction and in some cases, onset to MRONJ following extraction was in the span of years.

CONCLUSION

The decision to recommend extractions in patients previously exposed to intravenous bisphosphonates should take into account the severity of dental disease versus risk of MRONJ. In particular, the type and duration of bisphosphonate therapy should be considered. When extractions are performed in patients at-risk of MRONJ, they should be warned of the risk (around 4% in this study) and followed for a period appropriate to detect complications.