title: Declining Incidence of Medication-Related Osteonecrosis of the Jaw in Patients With Cancer.
abstract: BACKGROUND
  Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent, but severely debilitating condition. Given the significant morbidity attributable to MRONJ and the challenges associated with its management, prevention is crucial.
  
  
  OBJECTIVE
  We sought to evaluate the effectiveness of an active dental intervention in reducing MRONJ incidence.
  
  
  METHODS
  We identified all patients who received antiresorptive drug therapy at a specialized cancer center between January 2003 and December 2013 through hospital pharmacy records, whereas confirmed cases of MRONJ were identified through a hospital database.
  
  
  METHODS
  The incidence of MRONJ before and after the implementation of active dental intervention in July 2008 was quantified and compared.
  
  
  RESULTS
  A total of 1243 patients received antiresorptive drug therapy, with 34 confirmed cases of MRONJ (crude overall incidence, 2.7%). The incidence of MRONJ was significantly lower in patients who received antiresorptive therapy after the implementation of guidelines that emphasized active dental input (0.8 vs 4.6%; χ(2) = 16.2; P = .00006). Using a binominal logistic regression model that adjusted for the number of doses of antiresorptive drug received, patients who received active dental input had an odds ratio of developing MRONJ of 0.24 (95% confidence interval, 0.09, 0.61; P = .004).
  
  
  CONCLUSIONS
  The likelihood of developing MRONJ can be minimized through the implementation of prophylactic dental assessment and active dental intervention. This reinforces the importance of increased dental awareness and enhanced dental intervention in the prevention of MRONJ.
authors.affiliation: Western Campus, Melbourne Medical School (I.-W.S., K.M.S.), University of Melbourne, St Albans, Victoria 3021, Australia; Department of Endocrinology (I.-W.S.), Western Health, Melbourne, Victoria 3021, Australia; Department of Endocrinology (I.-W.S., P.R.E.), Monash Health, Melbourne, Victoria 3168, Australia; Institute of Health and Ageing (K.M.S.), Australian Catholic University, Melbourne, Victoria 3000, Australia; Melbourne Dental School (G.L.B.), University of Melbourne, Carlton, Victoria 3053, Australia; Department of Haematology (J.F.S.), Peter MacCallum Cancer Centre, Melbourne, and University of Melbourne, East Melbourne, Victoria 3002, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Melbourne, Victoria 3168, Australia.
authors.forename: Ie-Wen
authors.initials: IeW
authors.lastname: Sim
authors.affiliation: Western Campus, Melbourne Medical School (I.-W.S., K.M.S.), University of Melbourne, St Albans, Victoria 3021, Australia; Department of Endocrinology (I.-W.S.), Western Health, Melbourne, Victoria 3021, Australia; Department of Endocrinology (I.-W.S., P.R.E.), Monash Health, Melbourne, Victoria 3168, Australia; Institute of Health and Ageing (K.M.S.), Australian Catholic University, Melbourne, Victoria 3000, Australia; Melbourne Dental School (G.L.B.), University of Melbourne, Carlton, Victoria 3053, Australia; Department of Haematology (J.F.S.), Peter MacCallum Cancer Centre, Melbourne, and University of Melbourne, East Melbourne, Victoria 3002, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Melbourne, Victoria 3168, Australia.
authors.forename: Kerrie M
authors.initials: KM
authors.lastname: Sanders
authors.affiliation: Western Campus, Melbourne Medical School (I.-W.S., K.M.S.), University of Melbourne, St Albans, Victoria 3021, Australia; Department of Endocrinology (I.-W.S.), Western Health, Melbourne, Victoria 3021, Australia; Department of Endocrinology (I.-W.S., P.R.E.), Monash Health, Melbourne, Victoria 3168, Australia; Institute of Health and Ageing (K.M.S.), Australian Catholic University, Melbourne, Victoria 3000, Australia; Melbourne Dental School (G.L.B.), University of Melbourne, Carlton, Victoria 3053, Australia; Department of Haematology (J.F.S.), Peter MacCallum Cancer Centre, Melbourne, and University of Melbourne, East Melbourne, Victoria 3002, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Melbourne, Victoria 3168, Australia.
authors.forename: Gelsomina L
authors.initials: GL
authors.lastname: Borromeo
authors.affiliation: Western Campus, Melbourne Medical School (I.-W.S., K.M.S.), University of Melbourne, St Albans, Victoria 3021, Australia; Department of Endocrinology (I.-W.S.), Western Health, Melbourne, Victoria 3021, Australia; Department of Endocrinology (I.-W.S., P.R.E.), Monash Health, Melbourne, Victoria 3168, Australia; Institute of Health and Ageing (K.M.S.), Australian Catholic University, Melbourne, Victoria 3000, Australia; Melbourne Dental School (G.L.B.), University of Melbourne, Carlton, Victoria 3053, Australia; Department of Haematology (J.F.S.), Peter MacCallum Cancer Centre, Melbourne, and University of Melbourne, East Melbourne, Victoria 3002, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Melbourne, Victoria 3168, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Seymour
authors.affiliation: Western Campus, Melbourne Medical School (I.-W.S., K.M.S.), University of Melbourne, St Albans, Victoria 3021, Australia; Department of Endocrinology (I.-W.S.), Western Health, Melbourne, Victoria 3021, Australia; Department of Endocrinology (I.-W.S., P.R.E.), Monash Health, Melbourne, Victoria 3168, Australia; Institute of Health and Ageing (K.M.S.), Australian Catholic University, Melbourne, Victoria 3000, Australia; Melbourne Dental School (G.L.B.), University of Melbourne, Carlton, Victoria 3053, Australia; Department of Haematology (J.F.S.), Peter MacCallum Cancer Centre, Melbourne, and University of Melbourne, East Melbourne, Victoria 3002, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Melbourne, Victoria 3168, Australia.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Ebeling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology*; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003729:Dental Care / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D050071:Bone Density Conservation Agents