Evidence map›Paper›PMID 30406309›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2019

Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study.

T Hasegawa, S Hayashida, E Kondo, Y Takeda, H Miyamoto, Y Kawaoka, N Ueda, E Iwata, H Nakahara, M Kobayashi and 11 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
57citing papers in PubMed, 3 pooled it
2.8field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

57 citing papers in PubMed, 3 syntheses or guidelines pooled it, 93 citations in OpenAlex.

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  7. [Expert consensus on perioperative management of tooth extraction in patients receiving denosumab therapy].Hua xi kou qiang yi xue za zhi = Huaxi kouqiang yixue zazhi = West China journal of stomatology · 2026
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  20. Etiopathogenesis of medication-related osteonecrosis of the jaws: a review.Journal of molecular medicine (Berlin, Germany) · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors at 8 institutions in 1 country.

T HasegawaDepartment of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. hasetaku@med.kobe-u.ac.jp.
S HayashidaDepartment of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
E KondoDepartment of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Y TakedaDepartment of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan.
H MiyamotoDepartment of Oral Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Y KawaokaDepartment of Dentistry and Oral Surgery, Kansai Medical University, Hirakata, Japan.
N UedaDepartment of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan.
E IwataDepartment of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
H NakaharaDepartment of Oral and Maxillofacial Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
M KobayashiDepartment of Oral and Maxillofacial Surgery, Shin-Suma General Hospital, Kobe, Japan.
S SoutomeDepartment of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
S I YamadaDepartment of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
I TojyoDepartment of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan.
Y KojimaDepartment of Dentistry and Oral Surgery, Kansai Medical University, Hirakata, Japan.
M UmedaDepartment of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
S FujitaDepartment of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan.
H KuritaDepartment of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Y ShibuyaDepartment of Oral Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
T KiritaDepartment of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan.
T KomoriDepartment of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Japanese Study Group of Co-operative Dentistry with Medicine (JCDM)
Shinshu University · JPKansai Medical University · JPKobe University · JPNagasaki University · JPNara Medical University · JPOsaka City University · JPWakayama Medical University · JPNagoya City University · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Root amputation, immunosuppressive therapy, mandibular tooth extraction, pre-existing inflammation, and longer duration of treatment with bone-modifying agents were significantly associated with an increased risk of medication-related osteonecrosis of the jaw. Hopeless teeth should be extracted without drug holiday before the development of inflammation in cancer patients receiving high-dose bone-modifying agents.

introductionNo studies have comprehensively analyzed the influence of pre-existing inflammation, surgical procedure-related factors such as primary wound closure, demographic factors, and drug holiday on the incidence of medication-related osteonecrosis of the jaw (MRONJ). The purpose of this study was to retrospectively investigate the relationships between these various factors and the development of MRONJ after tooth extraction in cancer patients receiving high-dose bone-modifying agents (BMAs) such as bisphosphonates or denosumab.

methodsRisk factors for MRONJ after tooth extraction were evaluated with univariate and multivariate analyses. The following parameters were investigated in all patients: demographics, type and duration of BMA use, whether BMA use was discontinued before tooth extraction (drug holiday), the duration of such discontinuation, the presence of pre-existing inflammation, and whether additional surgical procedures (e.g., incision, removal of bone edges, root amputation) were performed.

resultsWe found that root amputation (OR = 22.62), immunosuppressive therapy (OR = 16.61), extraction of mandibular teeth (OR = 12.14), extraction of teeth with pre-existing inflammation, and longer duration (≥ 8 months) of high-dose BMA (OR = 7.85) were all significantly associated with MRONJ.

conclusionsTooth extraction should not necessarily be postponed in cancer patients receiving high-dose BMA. The effectiveness of a short-term drug holiday was not confirmed, as drug holidays had no significant impact on MRONJ incidence. Tooth extraction may be acceptable during high-dose BMA therapy until 8 months after initiation.

Indexed as

AdultAgedAged, 80 and overBisphosphonate-Associated Osteonecrosis of the JawBone Density Conservation AgentsDenosumabDiphosphonatesFemaleHumansImmunosuppressive AgentsMaleMiddle AgedNeoplasmsRetrospective StudiesRisk FactorsTooth ExtractionBone Density Conservation AgentsDenosumabDiphosphonatesImmunosuppressive AgentsBisphosphonateDenosumabDiscontinuationDrug holidayMRONJ

Identifiers

PMID30406309
OpenAlexW2899988391

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.