Incidence and risk of antiresorptive agent-related osteonecrosis of the jaw (ARONJ) after tooth extraction in patients w
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ORIGINAL ARTICLE
Incidence and risk of antiresorptive agent‑related osteonecrosis of the jaw (ARONJ) after tooth extraction in patients with autoimmune disease Yuichiro Fujieda1 · Mototsugu Doi1 · Takuya Asaka2 · Masahiro Ota3 · Ryo Hisada1 · Naoki Ohnishi1 · Michihiro Kono1 · Hiraku Kameda1 · Daigo Nakazawa1 · Masaru Kato1 · Olga Amengual1 · Masahiko Takahata3 · Shinsuke Yasuda1 · Yoshimasa Kitagawa2 · Tatsuya Atsumi1 Received: 15 June 2019 / Accepted: 2 February 2020 © The Japanese Society Bone and Mineral Research and Springer Japan KK, part of Springer Nature 2020
Abstract 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. Keywords Antiresorptive agents-related osteonecrosis of the jaw · Osteoporosis · Rheumatoid arthritis · Autoimmune disease
Introduction
Yuichiro Fujieda and Mototsugu Doi contributed equally to this work. * Yuichiro Fujieda [email protected] 1
Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
2
Oral Diagnosis and Medicine, Hokkaido University, Sapporo, Japan
3
Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
Prevention of osteoporosis is one of the key requirements in the management of patients with autoimmune disease (AID) under treatment with glucocorticoids. Antiresorptive agents (AR) including bisphosphonates (BP) and denosumab, an antibody-targeting receptor activator of nuclear factor kappa b ligand (RANKL), are administrated to modulate bone remodeling and increase bone mineral density (BMD) to reduce the likelihood of osteoporotic fracture (OF) and bone d
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