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Osteonecrosis of the Jaw in Patients Receiving Bone-Targeted Therapies: An Overview--Part I

Bruce Turner, Lawrence Drudge-Coates, Sacha Ali

    Urologic Nursing
    |August 10, 2016
    PubMed

    Insights

    Patients on bone-targeted therapies face osteonecrosis of the jaw (ONJ) risk. This review advocates for the term anti-bone resorption therapy-related osteonecrosis of the jaw (ABRT-ONJ) to encompass newer treatments.

    Area of Science:

    • Oncology
    • Pharmacology
    • Oral Surgery

    Background:

    • Bone-targeted therapies, including bisphosphonates and RANK-Ligand inhibitors, are crucial for managing bone metastases in cancer patients.
    • Osteonecrosis of the jaw (ONJ) is a recognized complication associated with these therapies, historically linked to bisphosphonates (BRONJ).
    • The emergence of other bone-modifying agents necessitates a broader terminology to accurately reflect the causative medications.

    Purpose of the Study:

    • To review the current understanding of the etiology and incidence of anti-bone resorption therapy-related osteonecrosis of the jaw (ABRT-ONJ).
    • To propose and advocate for the adoption of the term ABRT-ONJ to encompass ONJ associated with various bone-targeted therapies.
    • To present an audit of ONJ cases managed in a specialized bone support clinic.

    Main Methods:

    • Literature review of existing knowledge on ABRT-ONJ etiology and incidence.
    • Discussion of the evolution of terminology from BRONJ to ABRT-ONJ and the emerging term MRONJ.
    • Audit of ONJ cases within a nurse consultant-led bone support clinic, referencing zoledronic acid use in prostate cancer patients.

    Main Results:

    • Bone metastases affect a significant proportion of patients with advanced prostate and breast cancers.
    • Existing literature primarily describes bisphosphonate-related ONJ (BRONJ), but RANK-Ligand inhibitors also contribute to ONJ.
    • A lack of a universally accepted definition for ABRT-ONJ may impede its recognition and reporting.

    Conclusions:

    • The term anti-bone resorption therapy-related osteonecrosis of the jaw (ABRT-ONJ) is proposed to encompass ONJ linked to all bone-modifying agents.
    • Standardizing terminology is crucial for improving the recognition, reporting, and management of ONJ.
    • Further research and clinical audits are needed to fully understand the incidence and risk factors associated with ABRT-ONJ across different therapeutic agents.

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