Association between Hyperglycemia and Medication-Related Osteonecrosis of the Jaw (MRONJ)

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a type of jawbone necrosis caused by the use of drugs for some types of cancer and osteoporosis. The current study aimed to evaluate the associations between hyperglycemia and the development of medication-related osteonecrosis of the jaw. Methods: Our research group investigated data collected between 1 January 2019 and 31 December 2020. A total of 260 patients were selected from the Inpatient Care Unit, Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University. Fasting glucose data were used and included in the study. Results: Approximately 40% of the necrosis group and 21% of the control group presented with hyperglycemia. There was a significant association between hyperglycemia and MRONJ (p < 0.05, p = 0.003). Vascular anomaly and immune dysfunction caused by hyperglycemia can lead to necrosis after tooth extraction. Necrosis is more common in the mandible (75.0%) and in the case of parenteral antiresorptive treatment (intravenous Zoledronate and subcutaneous Denosumab). Hyperglycemia is a more relevant risk factor than bad oral habits (26.7%). Conclusions: Ischemia is a complication of abnormal glucose levels, a possible risk factor for necrosis development. Hence, uncontrolled or poorly regulated plasma glucose levels can significantly increase the risk of jawbone necrosis after invasive dental or oral surgical interventions.

[1]  E. Maiorano,et al.  Medication-related osteonecrosis of the jaw triggered by endodontic failure in oncologic patients. , 2022, Oral diseases.

[2]  S. Park,et al.  Effects of Type 2 Diabetes Mellitus on Osteoclast Differentiation, Activity, and Cortical Bone Formation in POSTmenopausal MRONJ Patients , 2022, Journal of clinical medicine.

[3]  E. Carlson,et al.  American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaw-2022 Update. , 2022, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[4]  Z. Natto,et al.  Medication-Related Osteonecrosis of the Jaw (MRONJ): A Review of Pathophysiology, Risk Factors, Preventive Measures and Treatment Strategies , 2022, The Saudi dental journal.

[5]  P. Hermann,et al.  Prevalence of Diabetes and Impaired Fasting Glycemia in Patients With Oral Cancer: A Retrospective Study in Hungary , 2021, AntiCancer Research.

[6]  Y. Sumita,et al.  Medication-related osteonecrosis of the jaw: Prosthodontic considerations , 2021, The Japanese dental science review.

[7]  M. Zillikens,et al.  Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organized by the ECTS , 2021, The Journal of clinical endocrinology and metabolism.

[8]  M. Tucci,et al.  Antiangiogenic Therapy in Clear Cell Renal Carcinoma (CCRC): Pharmacological Basis and Clinical Results , 2021, Cancers.

[9]  B. Hohlweg-Majert,et al.  Risk factors associated with onset of medication-related osteonecrosis of the jaw in patients treated with denosumab , 2021, Clinical Oral Investigations.

[10]  A. Viejo Llorente,et al.  Medication related osteonecrosis of the jaws (MRONJ): Factors related to recurrence after treatment with surgery and platelet rich plasma (PRP) placement , 2021, Medicina oral, patologia oral y cirugia bucal.

[11]  A. Frigo,et al.  A retrospective study on the incidence of medication-related osteonecrosis of the jaws (MRONJ) associated with different preventive dental care modalities , 2021, Supportive Care in Cancer.

[12]  J. I. Aguirre,et al.  Preclinical Models of Medication-related Osteonecrosis of the Jaw (MRONJ). , 2021, Bone.

[13]  M. Umeda,et al.  Relationship between tooth extraction and development of medication-related osteonecrosis of the jaw in cancer patients , 2021, Scientific Reports.

[14]  A. Berghuis,et al.  Phosphonate and Bisphosphonate Inhibitors of Farnesyl Pyrophosphate Synthases: A Structure-Guided Perspective , 2021, Frontiers in Chemistry.

[15]  C. Frazer-Cox.  New MRONJ guidance , 2020, British Dental Journal.

[16]  M. Schiødt,et al.  Preventing, identifying, and managing medication-related osteonecrosis of the jaw: a practical guide for nurses and other allied healthcare professionals , 2020, Supportive Care in Cancer.

[17]  M. Bornstein,et al.  Medication-related osteonecrosis of the jaws (MRONJ) in cancer patients treated with denosumab VS. zoledronic acid: A systematic review and meta-analysis , 2020, Medicina oral, patologia oral y cirugia bucal.

[18]  Qifu Li,et al.  Standards of medical care for type 2 diabetes in China 2019 , 2019, Diabetes/metabolism research and reviews.

[19]  G. Gazal.  Management of an emergency tooth extraction in diabetic patients on the dental chair , 2019, The Saudi dental journal.

[20]  N. Yarom,et al.  Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline. , 2019, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  V. Patel,et al.  Medication-related osteonecrosis of the jaw unrelated to bisphosphonates and denosumab-a review. , 2019, Oral surgery, oral medicine, oral pathology and oral radiology.

[22]  S. Cremers,et al.  Pharmacology of bisphosphonates. , 2019, British journal of clinical pharmacology.

[23]  M. Schiødt,et al.  Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. , 2019, Oral surgery, oral medicine, oral pathology and oral radiology.

[24]  G. Eckert,et al.  Assessing the Medical Emergency Preparedness of Dental Faculty, Residents, and Practicing Periodontists: An Exploratory Study. , 2018, Journal of dental education.

[25]  H. Hussein,et al.  Interventions for managing medication-related osteonecrosis of the jaw. , 2017, The Cochrane database of systematic reviews.

[26]  N. Kchir,et al.  Agressive infection following a dental extraction in a diabetic patient :Rhinocerebral mucormycosis. , 2017, La Tunisie medicale.

[27]  A. Pabst,et al.  Diabetes Mellitus and Its Association to the Occurrence of Medication-Related Osteonecrosis of the Jaw , 2016, Dentistry journal.

[28]  E. Rompen,et al.  Occurrence and risk indicators of medication-related osteonecrosis of the jaw after dental extraction: a systematic review and meta-analysis. , 2015, Journal of clinical periodontology.

[29]  M. Khamaisi,et al.  Diabetes as a Risk Factor for Medication-Related Osteonecrosis of the Jaw , 2015, Journal of dental research.

[30]  B. Balla,et al.  Potential significance of antiestrogen therapy in the development of bisphosphonate related osteonecrosis of the jaw. , 2014, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[31]  T. Dodson,et al.  American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. , 2014, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[32]  Yang Yao,et al.  Risk of osteonecrosis of the jaw in cancer patients receiving denosumab: a meta-analysis of seven randomized controlled trials , 2014, International Journal of Clinical Oncology.

[33]  S. Oudard,et al.  Antiangiogenic therapy for advanced renal cell carcinoma: Management of treatment-related toxicities , 2012, Investigational New Drugs.

[34]  Roy Taylor,et al.  Periodontitis and diabetes: a two-way relationship , 2011, Diabetologia.

[35]  A. Tripathi,et al.  Bisphosphonate therapy for skeletal malignancies and metastases: impact on jaw bones and prosthodontic concerns. , 2011, Journal of prosthodontics : official journal of the American College of Prosthodontists.

[36]  J. Vermorken,et al.  RANK ligand inhibition in bone metastatic cancer and risk of osteonecrosis of the jaw (ONJ): non bis in idem? , 2011, Supportive Care in Cancer.

[37]  S. Holst,et al.  Prosthodontic treatment of a patient with bisphosphonate-induced osteonecrosis of the jaw using a removable dental prosthesis with a heat-polymerized resilient liner: a clinical report. , 2010, The Journal of prosthetic dentistry.

[38]  L. Assael,et al.  American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws--2009 update. , 2009, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[39]  J. Yang,et al.  Immunotherapy for renal cell cancer. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[40]  R. Marx.  Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. , 2003, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[41]  P. Hermann,et al.  Point-of-care HbA1c Measurements in Oral Cancer and Control Patients in Hungary , 2022, In Vivo.

[42]  J. Nagy,et al.  Hypertonia és Covid-19 – I. rész Az életkor, az alapbetegségek és az ACEI/ARB kezelés jelentôsége hypertoniában és társbetegségeiben a SARS-CoV-2-fertôzés során , 2020 .

[43]  S. Soni,et al.  Glucose Levels and Hemodynamic Changes in Patients submitted to Routine Dental Extraction under Local Anesthesia with and without Adrenaline. , 2017, The journal of contemporary dental practice.

[44]  Jiang Zhu-lin.  Study of TNF-α,IL-1β and LPS Levels in the Gingival Crevicular Fluid of a Rat Model of Diabetes Mellitus and Periodontitis , 2014 .

[45]  J. Roush,et al.  Normal blood supply to the canine mandible and mandibular teeth. , 1989, American journal of veterinary research.