Incidence of Medication-Related Osteonecrosis of the Jaw in Patients With Breast Cancer During a 20-Year Follow-Up: A Population-Based Multicenter Retrospective Study
Abstract
PURPOSE Medication-related osteonecrosis of the jaw (MRONJ) is one of the most important toxicities of antiresorptive therapy, which is standard practice for patients with breast cancer and bone metastases. However, the population-based incidence of MRONJ is not well established. We therefore performed a retrospective multicenter study to assess the incidence for a whole Austrian federal state (Tyrol). MATERIALS AND METHODS This retrospective multicenter study was conducted between 2000 and 2020 at all nine breast centers across Tyrol, Austria. Using the cancer registry, the total Tyrolean population was screened for all patients with breast cancer. All patients with breast cancer and bone metastases receiving antiresorptive therapy were finally included in the study. RESULTS From 8,860 patients initially screened, 639 individuals were eligible and included in our study. Patients received antiresorptive therapy once per month without de-escalation of therapy. MRONJ was diagnosed in 56 (8.8%, 95% CI, 6.6 to 11.0) patients. The incidence of MRONJ was 11.6% (95% CI, 8.0 to 15.3) in individuals treated with denosumab only, 2.8% (95% CI, 0.7 to 4.8) in those treated with bisphosphonates only, and 16.3% (95% CI, 8.8 to 23.9) in the group receiving bisphosphonates followed by denosumab. Individuals developed MRONJ significantly earlier when treated with denosumab. Time to MRONJ after treatment initiation was 4.6 years for individuals treated with denosumab only, 5.1 years for individuals treated with bisphosphonates only, and 8.4 years for individuals treated with both consecutively. CONCLUSION MRONJ incidence in breast cancer patients with bone metastases was found to be considerably higher, especially for patients receiving denosumab, when compared with available data in the literature. Additionally, patients treated with denosumab developed MRONJ significantly earlier.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (24)
Christine Brunner
Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
Marjan Arvandi
Department of Public Health, Health Services Research and Health Technology Assessment, Medical Decision Making and Health Technology Assessment, Institute of Public Health, UMIT TIROL—University for Health Sciences and Technology, Hall in Tirol, Austria
Christian Marth
Daniel Egle
Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
Florentina Baumgart
Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
Miriam Emmelheinz
Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
Benjamin Walch
Department of Oral and Maxillofacial Surgery, Salzburg, Austria
Johanna Lercher
Department of Cranio-Maxillofacial and Oral Surgery, Medical University of Innsbruck, Innsbruck, Austria
Claudia Iannetti
Department of Visceral, Transplant and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
Ewald Wöll
15St. Vinzenz Hospital, Department of Internal Medicine, Zams, Austria
Agnes Pechlaner
Department of Internal Medicine, St Vinzenz Hospital, Zams, Austria
August Zabernigg
13County Hospital Kufstein, Department of Internal Medicine, Kufstein, Austria
Birgit Volgger
Department of Obstetrics and Gynecology, County Hospital Lienz, Lienz, Austria
Maria Castellan
Department of Obstetrics and Gynecology, County Hospital Lienz, Lienz, Austria
Oliver Tibor Andraschofsky
Department of Obstetrics and Gynecology, State Hospital Hall, Hall, Austria
Alice Markl
Department of Visceral Surgery, State Hospital Hall, Hall, Austria
Michael Hubalek
Department of Obstetrics and Gynecology, County Hospital Schwaz, Schwaz, Austria
Michael Schnallinger
Department of Internal Medicine, County Hospital St Johann, St Johann, Austria
Sibylle Puntscher
Department of Public Health, Health Services Research and Health Technology Assessment, Medical Decision Making and Health Technology Assessment, Institute of Public Health, UMIT TIROL—University for Health Sciences and Technology, Hall in Tirol, Austria
Uwe Siebert
Sebastian Schönherr
Lukas Forer
Emanuel Bruckmoser
Private Practice for Oral and Maxillofacial Surgery, Salzburg, Austria
Johannes Laimer
Private Practice for Oral and Maxillofacial Surgery, Lana, Italy