Adverse events caused by the discontinuation of anti-resorptive agents during treatment for anti-resorptive agent-related osteonecrosis of the jaw: A single-center cohort study

Objective: Anti-resorptive agent-related osteonecrosis of the jaw (ARONJ) is an adverse event that can remarkably affect a patient's quality of life. ARONJ is common in cancer patients with bone metastases and patients with osteoporosis who are treated with anti-resorptive agents (ARAs), including bisphosphonate and denosumab. However, the effects of discontinuing ARA treatment on outcomes of ARONJ remain unclear. This study aimed to investigate the benefits and risks of discontinuing ARAs during the treatment of ARONJ.Methods: This single-center cohort study evaluated 123 patients with osteoporosis and stage 1, 2, and 3 ARONJ from 2003 to 2018. The predictor variables evaluated included demographic, clinical, ARA treatment-related, and ARA use-related factors. We reviewed the medical records of patients to investigate the relationship between the discontinuation of ARAs and treatment outcomes of ARONJ.Results: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) was the most common type of ARONJ in this study. While 99 patients continued with ARA treatment, 24 of them discontinued it. We did not find a significant difference in the healing rates of the two groups. Of the patients who discontinued ARAs, four had fractures and one had a decrease in bone mineral density.Conclusions: Regardless of the primary disease, discontinuing ARA during the treatment of ARONJ may not have any significant benefits. Future studies should further evaluate the effects of discontinuing ARAs on the treatment of ARONJ. (C) 2020 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.