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Periosteal reaction of medication-related osteonecrosis of the jaw (MRONJ): clinical significance and changes during conservative therapy

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Abstract

Purpose

We previously reported that the periosteal reaction (PR) in medication-related osteonecrosis of the jaw (MRONJ) is a poor prognostic factor in surgical cases, but it is not clear how PR changes during conservative therapy. The purpose of this retrospective study was to compare computed tomography (CT) findings at the first visit and during follow-up visits in MRONJ patients subjected to conservative therapy and to investigate factors associated with the exacerbation of PR during conservative therapy.

Methods

Sixteen patients with MRONJ of the lower jaw who underwent conservative therapy and experienced a PR on CT images at the first visit and underwent CT examination again after 6 months or more were enrolled in the study. Clinical features and CT findings (extent of osteolytic lesion, extent of PR, type of PR, and changes during conservative treatment) were investigated.

Results

On the second CT scan, the osteolytic lesion improved in 4 patients, had not changed in 5, and deteriorated in 7, whereas the PR improved in 5 patients, had not changed in 4, and deteriorated in 7 patients. PR was significantly deteriorated in patients who continued to receive antiresorptive agents during conservative treatment and in patients with deteriorated osteolytic lesions.

Conclusion

PR in MRONJ often expands during conservative therapy and the PR type progresses from the attached type to the gap type, and the irregular type, but discontinuation of antiresorptive agent may improve PR as well as osteolytic lesions.

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Data availability

The datasets generated analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Author information

Author notes

  1. Mitsunobu Otsuru equally contributed first author

Authors and Affiliations

  1. Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan

    Sakiko Soutome & Toshiyuki Saito

  2. Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Mitsunobu Otsuru, Saki Hayashida, Souichi Yanamoto & Masahiro Umeda

  3. Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Miho Sasaki, Yukinori Takagi & Misa Sumi

  4. Department of Dentistry and Oral Surgery, Kansai Medical University, Osaka, Japan

    Yuka Kojima & Shunsuke Sawada

  5. Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, Osaka, Japan

    Hiroshi Iwai

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  1. Sakiko Soutome
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Contributions

(1) Conception and design: All authors

(2) Administrative support: Masahiro Umeda and Toshiyuki Saito

(3) Provision of study materials or patients: Sakiko Soutome and Mitsunobu Otsuru

(4) Collection and assembly of data: Sakiko Soutome, Mitsunobu Otsuru, Saki Hayashida, Yuka Kojima, Shunsuke Sawada, Miho Sasaki, Yukinori Takagi, and Misa Sumi

(5) Data analysis and interpretation: Masahiro Umeda and Hiroshi Iwai

(6) Manuscript writing: The first draft of the manuscript was written by Sakiko Soutome and Mitsunobu Otsuru

(7) Revision of the drafted manuscript critically for important intellectual content: All authors

(8) Approval of the version to be published: All authors

(9) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: All authors

Corresponding author

Correspondence to Sakiko Soutome.

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Ethics approval

This study was performed in accordance with the 1964 Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board (IRB) of Nagasaki University (#21021509).

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Because this was a retrospective study, the research plan was published on the homepage of the participating hospitals according to the instructions of the IRB in accordance with the guaranteed opt-out opportunity.

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Not applicable

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The authors declare no competing interests.

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Soutome, S., Otsuru, M., Hayashida, S. et al. Periosteal reaction of medication-related osteonecrosis of the jaw (MRONJ): clinical significance and changes during conservative therapy. Support Care Cancer 29, 6361–6368 (2021). https://doi.org/10.1007/s00520-021-06214-9

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  • DOI: https://doi.org/10.1007/s00520-021-06214-9

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