How does medication-related osteonecrosis of the jaw (MRONJ) influence the health-related quality of life after surgery?

BACKGROUND

Medication-Related Osteonecrosis of the Jaw (MRONJ), an established side effect of antiresorptive and antiangiogenic medication, could sometimes require surgical intervention, such as decortication. The objectives of this retrospective patient survey study were to evaluate the effect of surgical treated MRONJ on health-related quality of life (QoL) and to assess the awareness of the risk of MRONJ.

METHODS

The MRONJ-related QoL in both cancer and osteoporosis patients was determined in four different time periods after surgery applying the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30), a modified version of the Module for Head and Neck Cancer (H&N35) and MRONJ-specific questions. In addition the patients´ awareness of the risk of MRONJ when being prescribed the medication was examined. 65 patients with MRONJ (28 males and 37 females) who underwent surgery of the jaw were included in this study.

RESULTS

In comparison to normative data of the German population cancer and osteoporosis patients showed a reduction in their QoL in general. It was demonstrated that MRONJ causes an even further negative impact, particularly on role and social function. Amongst the MRONJ patients certain factors such as female sex, breast cancer as underlying disease, hypothyroidism, denture, nicotine abuse and multiple surgeries of the MRONJ were associated with worse QoL. The majority of patients suffered from a lack of knowledge regarding the risk of MRONJ when starting antiresorptive or antiangiogenic treatment. Unaware patients manifested worse QoL results and had to undergo more operations.

CONCLUSION

QoL of MRONJ patients is deteriorated and the number of surgeries and the patients´ awareness have a significant impact on QoL. In order to reach better awareness amongst both patients, doctors and other health care professionals and to detect MRONJ at an earlier stage, the H&N35 and MRONJ specific questions should be routinely administered to osteoporosis and cancer patients when starting antiresorptive or antiangiogenic treatment.