Introduction: Patients with hormone-receptor positive breast cancer (BC) often receive Adjuvant Endocrine Therapy (AET), which can cause Cancer Treatment-Induced Bone Loss (CTIBL). To prevent CTIBL, low-dose Bone-Modifying Agents such as bisphosphonates and Denosumab are prescribed. Although effective, these drugs can cause Medication-Related OsteoNecrosis of the Jaw, a rare but severe adverse event. The prevalence of MRONJ in this patient population is still unclear. Objectives: This study aims to estimate the prevalence of MRONJ in female patients with hormone-responsive BC on AET who are treated with low-dose BMAs to prevent CTIBL, evaluate the effectiveness of preventive dental visits in reducing MRONJ risk, and stratify the risk of MRONJ onset based on systemic and local risk factors. Materials and methods: A retrospective longitudinal cohort study of 200 patients was conducted at two centers in Italy. Medical history, clinical, and radiographic data were collected from medical records. Patients with MRONJ were evaluated for clinical signs, radiographic findings, intraoral risk factors, and staging according to SIPMO-SICMF (Italian Society of Oral Pathology and Medicine and Italian Society of Maxillofacial Surgery) and AAOMS (American Association of Oral And Maxillofacial Surgeons) criteria. Results: The MRONJ event occurred in 9/200 patients (4.5%); 44.5% of patients with MRONJ had received a preventive dental visit. The most frequent local risk factors were plaque and tartar (88.5%), root remnants (44.5%), and severe periodontitis (22.5%). Conclusions: The prevalence of MRONJ in females treated with low-dose BMAs is higher than reported in the literature. Moreover, in this female cohort, MRONJ risk seems to be higher than that of osteoporotic patients treated with low-dose BMAs and lower than in metastatic cancer patients treated with high-dose BMAs. Preventive dental visits seem to reduce the risk and severity of MRONJ. Various systemic and local risk factors contribute to the onset of MRONJ in this emerging population.
Prevalence and risk factors of MRONJ in breast cancer patients with CTIBL
Bacci, Christian
;Watutantrige - Fernando, Sara
2025
Abstract
Introduction: Patients with hormone-receptor positive breast cancer (BC) often receive Adjuvant Endocrine Therapy (AET), which can cause Cancer Treatment-Induced Bone Loss (CTIBL). To prevent CTIBL, low-dose Bone-Modifying Agents such as bisphosphonates and Denosumab are prescribed. Although effective, these drugs can cause Medication-Related OsteoNecrosis of the Jaw, a rare but severe adverse event. The prevalence of MRONJ in this patient population is still unclear. Objectives: This study aims to estimate the prevalence of MRONJ in female patients with hormone-responsive BC on AET who are treated with low-dose BMAs to prevent CTIBL, evaluate the effectiveness of preventive dental visits in reducing MRONJ risk, and stratify the risk of MRONJ onset based on systemic and local risk factors. Materials and methods: A retrospective longitudinal cohort study of 200 patients was conducted at two centers in Italy. Medical history, clinical, and radiographic data were collected from medical records. Patients with MRONJ were evaluated for clinical signs, radiographic findings, intraoral risk factors, and staging according to SIPMO-SICMF (Italian Society of Oral Pathology and Medicine and Italian Society of Maxillofacial Surgery) and AAOMS (American Association of Oral And Maxillofacial Surgeons) criteria. Results: The MRONJ event occurred in 9/200 patients (4.5%); 44.5% of patients with MRONJ had received a preventive dental visit. The most frequent local risk factors were plaque and tartar (88.5%), root remnants (44.5%), and severe periodontitis (22.5%). Conclusions: The prevalence of MRONJ in females treated with low-dose BMAs is higher than reported in the literature. Moreover, in this female cohort, MRONJ risk seems to be higher than that of osteoporotic patients treated with low-dose BMAs and lower than in metastatic cancer patients treated with high-dose BMAs. Preventive dental visits seem to reduce the risk and severity of MRONJ. Various systemic and local risk factors contribute to the onset of MRONJ in this emerging population.
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