Medication-Related Osteonecrosis of the Jaws in the Pediatric Population

Few reports have investigated medication-related osteonecrosis of the jaws (MRONJ) in the pediatric population. The study purpose was to measure the frequency of MRONJ in pediatric patients receiving antiresorptive medications at our institution.

This retrospective case series was granted an exemption by the University of Texas Southwestern Medical Center Institutional Review Board. The primary outcome variable was the presence or absence of MRONJ. Other variables of interest included 1) age at first dose of antiresorptive; 2) sex; 3) antiresorptive medication received; 4) reason for antiresorptive; 5) dental records available; 6) dental extractions that occurred after the start of antiresorptive; 7) exposure to immunosuppressants/chemotherapy; 8) time interval from the last dose of antiresorptive to dental extractions; and 9) longest follow-up after starting antiresorptive. Frequencies and proportions were calculated for categorical data. Medians, means, and standard deviations were calculated for continuous data.

The study sample was composed of 122 subjects. We observed 0 cases of MRONJ during the study interval. At the start of antiresorptive treatment, the average age was 8.18 years (range 0.02-17; standard deviation (SD) 5.15). There were 67 males (55%) and 55 females (45%). The reason for antiresorptive treatment was osteogenesis imperfecta in 36 patients, malignancy in 6 patients, and other in 80 patients. Thirty patients received pamidronate, 72 received zoledronate, 17 received a combination, and 3 received only denosumab. A total of 16 patients had exposure to immunosuppressants and/or chemotherapy. The average follow-up time was 4.89 years (median 4 years). Twenty-six patients underwent dental extractions of 74 teeth following antiresorptive treatment.

While there were no reported cases of MRONJ in the present study, it is advisable to monitor pediatric patients who have received antiresorptive treatment closely. When possible, appropriate dental treatment should be completed prior to starting antiresorptive therapy. In the absence of reported MRONJ cases, dental extractions should not be withheld because of previous antiresorptive exposure and antiresorptive medication dosing need not be altered in the pediatric population.