Cargando…

Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is an adverse event induced by antiresorptive agents (ARAs). The purpose of this study was to evaluate variables, mainly surgery and hyperbaric oxygen (HBO) therapy, associated with treatment outcomes in patients with a diagnosis of ARONJ...

Descripción completa

Detalles Bibliográficos
Autores principales: Watanabe, Takuma, Asai, Keita, Fukuhara, Shizuko, Uozumi, Ryuji, Bessho, Kazuhisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781475/
https://www.ncbi.nlm.nih.gov/pubmed/33395446
http://dx.doi.org/10.1371/journal.pone.0244859
_version_ 1783631683732373504
author Watanabe, Takuma
Asai, Keita
Fukuhara, Shizuko
Uozumi, Ryuji
Bessho, Kazuhisa
author_facet Watanabe, Takuma
Asai, Keita
Fukuhara, Shizuko
Uozumi, Ryuji
Bessho, Kazuhisa
author_sort Watanabe, Takuma
collection PubMed
description Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is an adverse event induced by antiresorptive agents (ARAs). The purpose of this study was to evaluate variables, mainly surgery and hyperbaric oxygen (HBO) therapy, associated with treatment outcomes in patients with a diagnosis of ARONJ at a single center. We enrolled consecutive patients who presented to our hospital for the management of stage 2 or 3 ARONJ between January 2003 and December 2019. The relationship between potentially predictive factors and outcome variables was examined using statistical analyses, along with a subgroup analysis based on disease stage. Of 252 patients included in this study, 206 had stage 2 ARONJ and 46 had stage 3 ARONJ. There were 119 patients with osteoporosis and 133 with malignant disease. In total, 139 patients were healed, and the healing rate of patients with stage 3 ARONJ was lower than that of patients with stage 2 ARONJ. With regard to the combination of surgery and HBO therapy, most patients underwent HBO before and after surgery. In the univariable analysis, surgery showed a therapeutic effect in both stage 2 and 3 ARONJ, whereas HBO showed a therapeutic effect in stage 2 ARONJ. In the multivariable analysis for stage 2 ARONJ, extensive surgery showed a stronger association with healing than conservative surgery, whereas ≥46 sessions of HBO therapy was less associated with healing than was non-HBO therapy. Our findings suggest that extensive surgery is highly effective against ARONJ regardless of disease stage if there is a sequestrum separation and systemic tolerance, whereas HBO therapy before and after surgical approach can be effective. Further studies are needed to identify treatment strategies for patients with treatment-refractory ARONJ who may be forced to undergo long-term HBO therapy with the expectation of sequestrum separation.
format Online
Article
Text
id pubmed-7781475
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-77814752021-01-07 Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage Watanabe, Takuma Asai, Keita Fukuhara, Shizuko Uozumi, Ryuji Bessho, Kazuhisa PLoS One Research Article Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is an adverse event induced by antiresorptive agents (ARAs). The purpose of this study was to evaluate variables, mainly surgery and hyperbaric oxygen (HBO) therapy, associated with treatment outcomes in patients with a diagnosis of ARONJ at a single center. We enrolled consecutive patients who presented to our hospital for the management of stage 2 or 3 ARONJ between January 2003 and December 2019. The relationship between potentially predictive factors and outcome variables was examined using statistical analyses, along with a subgroup analysis based on disease stage. Of 252 patients included in this study, 206 had stage 2 ARONJ and 46 had stage 3 ARONJ. There were 119 patients with osteoporosis and 133 with malignant disease. In total, 139 patients were healed, and the healing rate of patients with stage 3 ARONJ was lower than that of patients with stage 2 ARONJ. With regard to the combination of surgery and HBO therapy, most patients underwent HBO before and after surgery. In the univariable analysis, surgery showed a therapeutic effect in both stage 2 and 3 ARONJ, whereas HBO showed a therapeutic effect in stage 2 ARONJ. In the multivariable analysis for stage 2 ARONJ, extensive surgery showed a stronger association with healing than conservative surgery, whereas ≥46 sessions of HBO therapy was less associated with healing than was non-HBO therapy. Our findings suggest that extensive surgery is highly effective against ARONJ regardless of disease stage if there is a sequestrum separation and systemic tolerance, whereas HBO therapy before and after surgical approach can be effective. Further studies are needed to identify treatment strategies for patients with treatment-refractory ARONJ who may be forced to undergo long-term HBO therapy with the expectation of sequestrum separation. Public Library of Science 2021-01-04 /pmc/articles/PMC7781475/ /pubmed/33395446 http://dx.doi.org/10.1371/journal.pone.0244859 Text en © 2021 Watanabe et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Watanabe, Takuma
Asai, Keita
Fukuhara, Shizuko
Uozumi, Ryuji
Bessho, Kazuhisa
Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage
title Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage
title_full Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage
title_fullStr Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage
title_full_unstemmed Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage
title_short Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage
title_sort effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: a subgroup analysis by disease stage
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781475/
https://www.ncbi.nlm.nih.gov/pubmed/33395446
http://dx.doi.org/10.1371/journal.pone.0244859
work_keys_str_mv AT watanabetakuma effectivenessofsurgeryandhyperbaricoxygenforantiresorptiveagentrelatedosteonecrosisofthejawasubgroupanalysisbydiseasestage
AT asaikeita effectivenessofsurgeryandhyperbaricoxygenforantiresorptiveagentrelatedosteonecrosisofthejawasubgroupanalysisbydiseasestage
AT fukuharashizuko effectivenessofsurgeryandhyperbaricoxygenforantiresorptiveagentrelatedosteonecrosisofthejawasubgroupanalysisbydiseasestage
AT uozumiryuji effectivenessofsurgeryandhyperbaricoxygenforantiresorptiveagentrelatedosteonecrosisofthejawasubgroupanalysisbydiseasestage
AT besshokazuhisa effectivenessofsurgeryandhyperbaricoxygenforantiresorptiveagentrelatedosteonecrosisofthejawasubgroupanalysisbydiseasestage