The impact of a program of primary prevention in a dental setting on the incidence of osteonecrosis of the jaw in patients treated with zoledronic acid for bone metastases

Aim. The aim of the study was to investigate the incidence of medical related osteonecrosis of the jaw (MRONJ) after the set-up of structured programme of primary prevention before commencement and during treatment with zoledronic acid therapy taken for the treatment of bone metastasis in oncologic patients. Methods. In a prospective cohort study performed at the unit of dentistry and oral surgery of the university of Pisa, from September 2017 until September 2018, all patients with cancer with radiographic evidence of bone metastases and eligible for treatment with zoledronic acid were included and followed up until September 31, 2020. Results. Of the 300 patients, MRONJ developed in 7 (2.3%) during the 24 months of study. Female gender (OR 4.4; 95% CI 1.8-22,1; P = .043) and statin treatment (OR 25.1; 95% CI 0.1-2822; P < 0.001) were associated with an increased risk of MRONJ. Conclusions. In conclusion, MRONJ remains a significant risk associated with the use of antiresorptive drugs in the setting of malignancy. Importantly, this work reinforces the importance of a tailored program of prevention based on the evaluation of systemic and local risk factors