Wei Ling-Ying, Chiu Ching-Ming, Kok Sang-Heng, Lin Hung-Ying, Chiu Wei-Yih, Yang Chih-Wei, Lee Jang-Jaer
Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, No. 1, Chang-De Street, Taipei, 10048, Taiwan.
Department of Dentistry, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
Osteoporos Int. 2025 Mar 24. doi: 10.1007/s00198-025-07464-7.
Modulation of bone turnover by antiresorptive agents impairs wound healing of jaw bones, and can result in an adverse event termed medication-related osteonecrosis of the jaw (MRONJ). In recent years, the prevalence, risk factors, and prevention strategies for MRONJ have been extensively investigated, but only few studies have focused on its treatment outcome, and the proposed prognostic factors have varied greatly. We systematically reviewed the prognostic factors in patients undergoing treatment for MRONJ. In total, 33 studies met the inclusion criteria out of 1,388 screened citations. For analysis, we grouped the prognostic factors into five categories as follows: medication-related, underlying conditions, lesion-related, serum markers, and treatment modalities. Discontinuation of antiresorptive therapy was a medication-related factor significantly associated with better treatment outcomes. Regarding underlying conditions, malignancy, especially multiple myeloma, was associated with worse treatment outcomes. Among lesion-related factors, better treatment outcome was noted for maxillary lesions and lesions with sequestrum formation. By contrast, lesions of advanced stages and those with periosteal reaction had poor treatment outcomes. Regarding treatment modality, surgical therapy was associated with a better chance of healing. Results of our meta-analysis helped identify prognostic indicators of MRONJ and will assist in decision-making in the clinical setting. Based on our results, surgeons may have a better cognitive context to discuss treatment options with patients. Additionally, our findings provide convincing evidence for physicians to consider postponing antiresorptive therapy in patients with MRONJ lesions.
抗吸收药物对骨转换的调节会损害颌骨的伤口愈合，并可能导致一种称为药物相关性颌骨坏死（MRONJ）的不良事件。近年来，对MRONJ的患病率、危险因素和预防策略进行了广泛研究，但只有少数研究关注其治疗结果，且所提出的预后因素差异很大。我们系统回顾了接受MRONJ治疗患者的预后因素。在1388篇筛选出的文献中，共有33项研究符合纳入标准。为了进行分析，我们将预后因素分为以下五类：药物相关因素、基础疾病、病变相关因素、血清标志物和治疗方式。停用抗吸收治疗是与更好治疗结果显著相关的药物相关因素。关于基础疾病，恶性肿瘤，尤其是多发性骨髓瘤，与较差的治疗结果相关。在病变相关因素中，上颌病变和有死骨形成的病变治疗结果较好。相比之下，晚期病变和有骨膜反应的病变治疗结果较差。关于治疗方式，手术治疗愈合机会更大。我们的荟萃分析结果有助于确定MRONJ的预后指标，并将有助于临床决策。根据我们的结果，外科医生在与患者讨论治疗方案时可能有更好的认知背景。此外，我们的研究结果为医生考虑推迟对患有MRONJ病变的患者进行抗吸收治疗提供了令人信服的证据。
