title: Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw.
abstract: Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is an intractable, though rare, complication in cancer patients with bone metastases and patients with osteoporosis who are treated with antiresorptive agents, including bisphosphonates and denosumab. Despite the more than 10 years that have passed since the first cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) were reported, our understanding of the epidemiology and pathophysiology of ARONJ remains limited, and data supported by evidence-based medicine are still sparse. However, the diagnosis and staging of ARONJ, identification of risk factors, and development of preventive and therapeutic approaches have advanced significantly over the past decade. The Position Paper 2017 is an updated version of the Position Paper 2010 of the Japanese Allied Committee on Osteonecrosis of the Jaw, which now comprises six Japanese academic societies. The Position Paper 2017 describes a new diagnostic definition for ARONJ, as proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), summarizes our current understanding of the pathophysiology of ARONJ based on a literature search, and suggests methods for physicians and dentists/oral surgeons to manage the disease. In addition, the appropriateness of discontinuing antiresorptive medications (drug holiday) before, during, and after invasive dental treatments is discussed extensively. More importantly, the manuscript also proposes, for the first time, the importance of interactive communication and cooperation between physicians and dentists/oral surgeons for the successful treatment of ARONJ. The Position Paper 2017 is intended to serve as a guide for improving the management of ARONJ patients in Japan.
authors.affiliation: Division of Hematology and Oncology, Indiana University School of Medicine, Indianapolis, USA. toshyone@iu.edu.|The Japanese Society for Bone and Mineral Research, Kyoto, Japan. toshyone@iu.edu.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Yoneda
authors.affiliation: School of Health Science, Faculty of Medicine, Tottori University, Tottori, Japan.|The Japanese Society for Bone and Mineral Research, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hagino
authors.affiliation: Internal Medicine 1, Shimane University Faculty of Medicine, Matsue, Japan.|The Japanese Society for Bone and Mineral Research, Kyoto, Japan.
authors.forename: Toshitsugu
authors.initials: T
authors.lastname: Sugimoto
authors.affiliation: Clinical Research Centers for Medicine, International University of Health and Welfare, Ohtawara, Japan.|The Japan Osteoporosis Society, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohta
authors.affiliation: Department of Medical Oncology, The Cancer Institute Hospital Of Japanese Foundation of Cancer Research, Tokyo, Japan.|The Japanese Society for Bone and Mineral Research, Kyoto, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Orthopaedic Surgery and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan.|The Japan Osteoporosis Society, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Soen
authors.affiliation: Department of Hard Tissue Research, Graduate School of Oral Medicine, Matsumoto Dental University, Shiojiri, Japan.|The Japanese Society of Oral and Maxillofacial Radiology, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Taguchi
authors.affiliation: Department of Periodontology and Endodontology, School of Dentistry, Tokushima University, Tokushima, Japan.|The Japanese Society of Periodontology, Tokyo, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Nagata
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Japan.|The Japanese Society of Oral and Maxillofacial Surgeons, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Urade
authors.affiliation: Department of Oral and Maxillo-Facial Surgery, Tokyo Dental College, Tokyo, Japan.|The Japanese Society of Oral and Maxillofacial Surgeons, Tokyo, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Shibahara
authors.affiliation: Department of Oral Pathology, Osaka University Graduate School of Dentistry, Suita, Japan.|The Japanese Society of Oral Pathology, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Toyosawa
mesh_terms: D044466:Asian People; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000175:diagnosis* / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D010506:Periodicals as Topic; D017410:Practice Guidelines as Topic
keywords: Bisphosphonates; Denosumab; Drug holidays; Oral bacterial infection; Osteonecrosis of the jaw; Team therapeutic approaches