Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysis
Purpose: Controversy exists on whether a drug holiday is necessary for patients on antiresorptive medication for osteoporosis or bone metastasis and undergoing dental procedures to lower the risk of medication-related osteonecrosis of the jaw (MRONJ). This study evaluated the effects of discontinuin...
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Bioscientifica
2025-05-01
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| Series: | EFORT Open Reviews |
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| Online Access: | https://eor.bioscientifica.com/view/journals/eor/10/5/EOR-2024-0133.xml |
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| author | Kasidid Ruksakiet Atthakorn Jarusriwanna Wuttapon Sadaeng Artit Laoruengthana Thanyaporn Sang-Ngoen Teerapon Dhippayom |
| author_facet | Kasidid Ruksakiet Atthakorn Jarusriwanna Wuttapon Sadaeng Artit Laoruengthana Thanyaporn Sang-Ngoen Teerapon Dhippayom |
| author_sort | Kasidid Ruksakiet |
| collection | DOAJ |
| description | Purpose: Controversy exists on whether a drug holiday is necessary for patients on antiresorptive medication for osteoporosis or bone metastasis and undergoing dental procedures to lower the risk of medication-related osteonecrosis of the jaw (MRONJ). This study evaluated the effects of discontinuing different antiresorptive regimens on MRONJ in these patients. Methods: Publications from PubMed, EMBASE, Cochrane Library and EBSCO Open Dissertations were searched from inception to September 2023 following PRISMA guidelines, and the review was registered in PROSPERO. Eligibility criteria included clinical studies on the effects of continued and discontinued antiresorptive medications for osteoporosis or bone metastasis in patients undergoing dental procedures. The involved antiresorptive agents were oral bisphosphonates (BPs), intravenous (IV) BPs and denosumab (Dmab). Relative risk (RR) with 95% confidence interval (CI) was estimated using a random-effects model. Results: Of the 2,590 records identified, six studies (n = 717) were included. Discontinued use of oral BPs had a lower MRONJ risk than discontinuation of IV BPs (RR = 0.05; 95% CI: 0.00–0.83) and continuation of IV BPs (RR = 0.03; 95% CI: 0.00–0.46). Continuing oral BPs also resulted in a lower MRONJ risk compared to both discontinuation and continuation of IV BPs, with RR = 0.04 (95% CI: 0.00–0.67) and RR = 0.03 (95% CI: 0.00–0.37), respectively. No significant difference was found between continuation and discontinuation of oral BPs, along with other comparisons. Conclusions: A drug holiday may not be necessary before dental procedures for oral BPs. Temporary discontinuation of IV BPs or Dmab is also unlikely to reduce MRONJ risk compared to continued medication. |
| format | Article |
| id | doaj-art-8bab3214fdea40d38c213e1d2ddc77f9 |
| institution | DOAJ |
| issn | 2058-5241 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Bioscientifica |
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| series | EFORT Open Reviews |
| spelling | doaj-art-8bab3214fdea40d38c213e1d2ddc77f92025-08-20T02:59:07ZengBioscientificaEFORT Open Reviews2058-52412025-05-0110525826610.1530/EOR-2024-01331Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysisKasidid Ruksakiet0Atthakorn Jarusriwanna1Wuttapon Sadaeng2Artit Laoruengthana3Thanyaporn Sang-Ngoen4Teerapon Dhippayom5Department of Restorative Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, ThailandDepartment of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, ThailandDepartment of Oral Diagnosis, Faculty of Dentistry, Naresuan University, Phitsanulok, ThailandDepartment of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, ThailandDepartment of Oral Biology, Faculty of Dentistry, Naresuan University, Phitsanulok, ThailandThe Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, ThailandPurpose: Controversy exists on whether a drug holiday is necessary for patients on antiresorptive medication for osteoporosis or bone metastasis and undergoing dental procedures to lower the risk of medication-related osteonecrosis of the jaw (MRONJ). This study evaluated the effects of discontinuing different antiresorptive regimens on MRONJ in these patients. Methods: Publications from PubMed, EMBASE, Cochrane Library and EBSCO Open Dissertations were searched from inception to September 2023 following PRISMA guidelines, and the review was registered in PROSPERO. Eligibility criteria included clinical studies on the effects of continued and discontinued antiresorptive medications for osteoporosis or bone metastasis in patients undergoing dental procedures. The involved antiresorptive agents were oral bisphosphonates (BPs), intravenous (IV) BPs and denosumab (Dmab). Relative risk (RR) with 95% confidence interval (CI) was estimated using a random-effects model. Results: Of the 2,590 records identified, six studies (n = 717) were included. Discontinued use of oral BPs had a lower MRONJ risk than discontinuation of IV BPs (RR = 0.05; 95% CI: 0.00–0.83) and continuation of IV BPs (RR = 0.03; 95% CI: 0.00–0.46). Continuing oral BPs also resulted in a lower MRONJ risk compared to both discontinuation and continuation of IV BPs, with RR = 0.04 (95% CI: 0.00–0.67) and RR = 0.03 (95% CI: 0.00–0.37), respectively. No significant difference was found between continuation and discontinuation of oral BPs, along with other comparisons. Conclusions: A drug holiday may not be necessary before dental procedures for oral BPs. Temporary discontinuation of IV BPs or Dmab is also unlikely to reduce MRONJ risk compared to continued medication.https://eor.bioscientifica.com/view/journals/eor/10/5/EOR-2024-0133.xmlantiresorptivesbisphosphonatesdenosumabosteonecrosis of the jawosteoporosisbone metastasis |
| spellingShingle | Kasidid Ruksakiet Atthakorn Jarusriwanna Wuttapon Sadaeng Artit Laoruengthana Thanyaporn Sang-Ngoen Teerapon Dhippayom Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysis EFORT Open Reviews antiresorptives bisphosphonates denosumab osteonecrosis of the jaw osteoporosis bone metastasis |
| title | Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysis |
| title_full | Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysis |
| title_fullStr | Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysis |
| title_full_unstemmed | Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysis |
| title_short | Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysis |
| title_sort | effects of discontinuing different antiresorptive regimens on medication related osteonecrosis of the jaw in patients undergoing dental procedures a systematic review and network meta analysis |
| topic | antiresorptives bisphosphonates denosumab osteonecrosis of the jaw osteoporosis bone metastasis |
| url | https://eor.bioscientifica.com/view/journals/eor/10/5/EOR-2024-0133.xml |
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