Extensive Surgical Procedures Result in Better Treatment Outcomes for Bisphosphonate-Related Osteonecrosis of the Jaw in Patients with Osteoporosis

Abstract Purpose To identify risk factors associated with relapse or treatment failure after surgery for bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients with osteoporosis. Patients and Methods This is a retrospective cohort study on BRONJ in patients with osteoporosis who underwent surgical procedures between 2004 and 2016 at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. The predictor variables comprised a set of heterogeneous variables, including demographic (age, gender), anatomic (maxilla, mandible, or both; affected location), clinical (disease stage; etiology; comorbidities; history of intravenous bisphosphonate intake), time (conservative treatment before surgery; bisphosphonate treatment before the development of BRONJ; discontinuation of the drug before surgery; time to final follow-up; time to re-operation in case of relapse or treatment failure), and perioperative variables (type of anesthesia; type of surgical procedures). The primary outcome variable was relapse after surgery that required reoperation (yes/no). The descriptive and bivariate statistics were computed to assess the relationships between the study variables and the outcome. To determine risk factors, we conducted a survival analysis with the Cox model. Results The final sample included 325 subjects with a median age of 75 years; 97% were female. After surgery, 30% patients did not completely recuperate and underwent repeat surgery. The time from the first surgery to reoperation ranged from 10 days to 5.6 years. Relapse or failures of treatment most often occurred immediately after surgery. The type of surgical procedure and mode of anesthesia were the most important factors in the treatment outcome. A drug holiday did not appear to influence the likelihood of relapse after surgery. Conclusions Treatment for BRONJ in patients with osteoporosis might benefit from more careful and extensive surgical procedures rather than curettage performed with local anesthesia.