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Background <p>Breast cancer is one of the most common cancers among women, with improved therapies reducing mortality. Antiresorptive (AR) therapy is crucial for managing bone loss and skeletal complications in patients with cancer. However, high-dose AR therapy may carry a significant risk of medication-related osteonecrosis of the jaw (MRONJ). This study aimed to investigate the incidence of MRONJ and its risk factors in patients with diagnosed breast cancer undergoing either biannual postoperative bisphosphonate therapy or high-dose AR therapy.</p> Methods <p>This study followed 220 female patients receiving AR therapy in Sweden, from 2015 to 2020. Oral health status was assessed before and during AR therapy, collecting data on MRONJ incidence, dental procedures, and data on breast cancer characteristics. Statistical analyses included Fisher’s exact tests, and group differences in Kaplan-Meier curves were assessed using the log-rank test. <i>p</i> &lt; 0.05 was considered statistically significant.</p> Results <p>The cohort comprised 119 patients on biannual AR therapy and 101 patients on high-dose AR therapy. Nine patients (4.0%) developed bone metastases and transitioned to high-dose AR therapy after a mean interval of 237 days; of these, 55.5% subsequently switched from bisphosphonates to denosumab. MRONJ cumulative incidence was 5.5% in the overall cohort and 11.9% in the high-dose group (<i>p</i> &lt; 0.001); no MRONJ cases occurred in the biannual group. Tooth extractions (30.5%, <i>p</i> &lt; 0.001), localisation to the mandible (83.3%, <i>p</i> = 0.039) and number of AR doses (<i>p</i> = 0.004) were significantly associated with the development of MRONJ. Notably, spontaneous MRONJ accounted for 41.7% of cases. Baseline DMFT did not differ, but MRONJ patients had a higher DMFT increment during follow-up.</p> Conclusions <p>This study identifies a significant association between high-dose AR therapy and the development of MRONJ in breast cancer patients, with tooth extractions, mandibular localisation, and cumulative AR exposure identified as risk factors. MRONJ was not observed in the biannual AR therapy group. These findings underscore the importance of comprehensive dental assessments and early risk stratification.</p>

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Medication-related osteonecrosis of the jaw in breast cancer patients: a longitudinal observational Swedish study of oral health and antiresorptive use

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  • 发表日期：

    2026年7月15日

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  • Magdalena Korytowska,
  • Gunnar Lengstrand,
  • Anna Ljunggren,
  • Per-Erik Isberg,
  • Cecilia Larsson Wexell

摘要

Background

Breast cancer is one of the most common cancers among women, with improved therapies reducing mortality. Antiresorptive (AR) therapy is crucial for managing bone loss and skeletal complications in patients with cancer. However, high-dose AR therapy may carry a significant risk of medication-related osteonecrosis of the jaw (MRONJ). This study aimed to investigate the incidence of MRONJ and its risk factors in patients with diagnosed breast cancer undergoing either biannual postoperative bisphosphonate therapy or high-dose AR therapy.

Methods

This study followed 220 female patients receiving AR therapy in Sweden, from 2015 to 2020. Oral health status was assessed before and during AR therapy, collecting data on MRONJ incidence, dental procedures, and data on breast cancer characteristics. Statistical analyses included Fisher’s exact tests, and group differences in Kaplan-Meier curves were assessed using the log-rank test. p < 0.05 was considered statistically significant.

Results

The cohort comprised 119 patients on biannual AR therapy and 101 patients on high-dose AR therapy. Nine patients (4.0%) developed bone metastases and transitioned to high-dose AR therapy after a mean interval of 237 days; of these, 55.5% subsequently switched from bisphosphonates to denosumab. MRONJ cumulative incidence was 5.5% in the overall cohort and 11.9% in the high-dose group (p < 0.001); no MRONJ cases occurred in the biannual group. Tooth extractions (30.5%, p < 0.001), localisation to the mandible (83.3%, p = 0.039) and number of AR doses (p = 0.004) were significantly associated with the development of MRONJ. Notably, spontaneous MRONJ accounted for 41.7% of cases. Baseline DMFT did not differ, but MRONJ patients had a higher DMFT increment during follow-up.

Conclusions

This study identifies a significant association between high-dose AR therapy and the development of MRONJ in breast cancer patients, with tooth extractions, mandibular localisation, and cumulative AR exposure identified as risk factors. MRONJ was not observed in the biannual AR therapy group. These findings underscore the importance of comprehensive dental assessments and early risk stratification.