Does Drug Holiday Affect Jaw Trabeculation in Medication Related Osteonecrosis of the Jaw? – A Pilot Study

BACKGROUND: The role of drug holiday in long term antiresorptive drug users to prevent MRONJ is debated for quite some time. We aimed to compare jawbone trabeculation between patients on drug holiday with those not on drug holiday among Medication Related Osteonecrosis of the Jaw (MRONJ) cases using fractal analysis and to estimate the frequency of MRONJ despite being on drug holiday. MATERIAL AND METHODS: The sample of 18 MRONJ cases were divided into drug holiday, and non-drug holiday groups. Non-drug holiday group was further divided into pre- and post- drug holiday groups. Jawbone trabeculation was assessed utilizing fractal analysis method (ImageJ software) by two observers. ANOVA was used to compare the fractal dimension (FD) values between the groups. A ‘p’ value of less than 0.05 was considered significant. RESULTS: 8 patients developed MRONJ despite being on drug holiday (44.44%). There was no significant difference in the FD values between drug holiday and pre-drug holiday groups. When pre- and post-drug holiday FD values were compared, the difference was significant only on the right maxilla with observer 2. Also, no significant difference was noted between the two observers. CONCLUSIONS: Bone trabeculation remained unaltered following drug holiday from anti-resorptive drugs. This study serves as a preliminary proof for the argument against drug holiday which portrays the necessity for a detailed prospective study in this arena. Key words:Osteonecrosis, bisphosphonates, Bisphosphonate-Associated Osteonecrosis of the Jaw, anti-resorptive drugs, osteoporosis, jaw.