Incidence and risk of antiresorptive agent-related osteonecrosis of the jaw (ARONJ) after tooth extraction in patients with autoimmune disease

• Published in: Journal of bone and mineral metabolism 2020-07, Vol.38 (4), p.581-588
• Main Authors: Fujieda, Yuichiro, Doi, Mototsugu, Asaka, Takuya, Ota, Masahiro, Hisada, Ryo, Ohnishi, Naoki, Kono, Michihiro, Kameda, Hiraku, Nakazawa, Daigo, Kato, Masaru, Amengual, Olga, Takahata, Masahiko, Yasuda, Shinsuke, Kitagawa, Yoshimasa, Atsumi, Tatsuya
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Autoimmune diseases; Autoimmune Diseases - complications; Bisphosphonate-Associated Osteonecrosis of the Jaw - epidemiology; Bisphosphonate-Associated Osteonecrosis of the Jaw - etiology; Bisphosphonate-Associated Osteonecrosis of the Jaw - therapy; Bone Density Conservation Agents - adverse effects; Diphosphonates - adverse effects; Female; Humans; Incidence; Jaw; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Original Article; Orthopedics; Osteonecrosis; Osteoporosis; Osteoporotic Fractures - complications; Population studies; Retrospective Studies; Risk Factors; Teeth; Tooth Extraction - adverse effects; Tooth extractions; Withholding Treatment; Young Adult
• ISSN: 0914-8779; 1435-5604
• DOI: 10.1007/s00774-020-01089-y

Introduction Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is a rare but serious complication in patients receiving antiresorprtive agents (AR). However, the incidence of ARONJ after tooth extraction in patients with autoimmune disease (AID) remains unclear. The present study aimed to clarify the high-risk population of ARONJ in patients with AID. Materials and methods The study population comprised 232 patients treated with AR, AID or non-AID, who had undergone dental extraction from January 2011 to September 2017. The incidence and risk factors of ARONJ were analysed retrospectively. Additionally, the relationship between ARONJ and osteoporotic fracture (OF) and AR discontinuation during dental procedures was investigated. Results Of 232 patients, 10 developed ARONJ within 1 year of dental extraction. The incidence of ARONJ in patients with AID was higher than that in non-AID patients (2.0/100 person-year vs 0.5/100 person-year; p  = 0.03). Among the AID patients, RA patients had strikingly high incidence of ARONJ (3.6/100 person-year). The incidence of neither ARONJ nor OF significantly differed between patients who continued and discontinued AR in the perioperative period. Conclusion Patients with AID who undergo dental extraction are at high risk of ARONJ. Discontinuation of AR would not significantly contribute to reduce the incidence of ARONJ in those patients.