title: Disease Stage and Mode of Therapy Are Important Determinants of Treatment Outcomes for Medication-Related Osteonecrosis of the Jaw.
abstract: OBJECTIVE
  The treatment of patients with medication-related osteonecrosis of the jaw (MRONJ) is challenging. The purpose of the present study was to estimate the frequency and identify the factors associated with clinical improvement during treatment.
  
  
  METHODS
  We designed and implemented a retrospective cohort study and enrolled a sample of subjects diagnosed with MRONJ between 2004 and 2015. The primary predictor variables were a set of heterogeneous variables grouped into the following categories: demographic (age and gender) and clinical (location of necrosis, therapy duration, medication type, disease stage, and treatment type). The primary outcome variable was the treatment outcome, defined as stable or worse and improved or healed. The descriptive, bivariate, and multiple logistic statistics were computed, and statistical significance was defined as P < .05.
  
  
  RESULTS
  The sample included 337 subjects with a mean age of 68.9 years. Of the 337 subjects, 256 were women (76%). A total of 143 patients (42.2%) experienced spontaneous necrosis. Twenty-four (7.1%) had had exposure to targeted antiangiogenic agents. Those with stage 1 or 2 disease were more likely to have better outcomes than those with stage 3 disease (stage 1, adjusted odds ratio [OR] 3.4, P = .005; stage 2, adjusted OR 2.2, P = .03). Treatment type was a significant variable. Subjects undergoing surgery were 28 times more likely to have a positive outcome than those receiving nonoperative therapy (adjusted OR 28.7, P < .0001).
  
  
  CONCLUSIONS
  Subjects with MRONJ who presented with less severe disease or who underwent operative treatment were most likely to have improvement or complete healing of their MRONJ-related lesions.
authors.affiliation: Clinical Professor, Division of Oral and Maxillofacial Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY; Stony Brook School of Dental Medicine, Stony Brook, NY; New York Center for Orthognathic and Maxillofacial Surgery, New York, NY. Electronic address: sruggie@optonline.net.
authors.forename: Salvatore L
authors.initials: SL
authors.lastname: Ruggiero
authors.affiliation: Senior Biostatistician, Biostatistics Unit, Feinstein Institute for Medical Research, North Shore Long Island Jewish Health System, Manhasset, NY.
authors.forename: Nina
authors.initials: N
authors.lastname: Kohn
mesh_terms: D000368:Aged; D000541:Alveolectomy / Q000379:methods; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000145:classification* / Q000188:drug therapy / Q000601:surgery; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000145:classification / Q000188:drug therapy / Q000601:surgery; D008439:Maxillary Diseases / Q000145:classification / Q000188:drug therapy / Q000601:surgery; D008875:Middle Aged; D009067:Mouthwashes / Q000627:therapeutic use; D009369:Neoplasms / Q000188:drug therapy; D010024:Osteoporosis / Q000188:drug therapy; D010027:Osteotomy / Q000379:methods; D053245:RANK Ligand / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D050071:Bone Density Conservation Agents; D009067:Mouthwashes; D053245:RANK Ligand; C505688:TNFSF11 protein, human