The Influence of Vitamin D Levels and Supplementation on the Treatment of Patients Affected by MRONJ
<b>Background:</b> Advancements in pharmacology have led to the introduction of novel antiresorptive and antiangiogenic drugs, which are associated with the side effect of medication-related osteonecrosis of the jaw (MRONJ). The aim of this study was to evaluate the impact of different b...
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| author | Filip Michalak Marzena Dominiak Jan Kiryk Paweł Popecki Dominik Kubicki Jacek Matys Kinga Grzech-Leśniak |
| author_facet | Filip Michalak Marzena Dominiak Jan Kiryk Paweł Popecki Dominik Kubicki Jacek Matys Kinga Grzech-Leśniak |
| author_sort | Filip Michalak |
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| description | <b>Background:</b> Advancements in pharmacology have led to the introduction of novel antiresorptive and antiangiogenic drugs, which are associated with the side effect of medication-related osteonecrosis of the jaw (MRONJ). The aim of this study was to evaluate the impact of different blood levels of vitamin D on the course of treatment, as well as the role of vitamin D supplementation during the treatment of primary diseases involving bisphosphonates or denosumab. Methods: The clinical trial involved 64 patients diagnosed with medication-related osteonecrosis of the jaw (MRONJ) treated at the Department of Oral Surgery. Participants underwent baseline panoramic radiographs and Cone Beam Computed Tomography (CBCT) scans, with MRONJ severity categorized according to the AAOMS classification. This study included two groups: 37 patients (n = 37) in the experimental group received high-dose vitamin D supplementation (10,000 IU/day for 4 weeks, followed by a maintenance dose of 5000 IU/day), while 27 patients (n = 27) in the control group received no supplementation. Vitamin D levels were measured at baseline, 3 months, and 6 months, and the relationship between vitamin D supplementation and clinical outcomes, including MRONJ risk and healing, was evaluated. All participants received an antibiotic regimen pre- and post-surgery. Pain intensity was assessed at multiple time points using the Visual Analog Scale (VAS). Results: This study showed significant increases in serum vitamin D levels in the experimental group at 3 and 6 months (<i>p</i> < 0.05). In the prophylactic context, Vitamin D supplementation prior to or during tooth extraction reduced the risk of developing severe MJRON (OR = 68.57; <i>p</i> < 0.001). In the therapeutic context among patients with established MJRON, vitamin D supplementation did not significantly predict postoperative complications (<i>p</i> = 0.079) or complete healing (OR = 2.34; <i>p</i> = 0.051). However, overall healing rates were somewhat higher in the supplemented group, though they did not reach statistical significance. Antibiotic protection uses also reduced the need for further treatment (OR = 6.20; <i>p</i> < 0.001). Conclusions: Prophylactic high-dose vitamin D supplementation may help prevent severe MRONJ in at-risk patients undergoing tooth extraction. Once MRONJ is established, however, vitamin D alone may not significantly alter immediate postoperative outcomes, although further research is needed to clarify its potential adjunctive benefits. |
| format | Article |
| id | doaj-art-02997712744c42e19d98b0328c38203e |
| institution | Kabale University |
| issn | 2076-3417 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-02997712744c42e19d98b0328c38203e2025-01-24T13:20:22ZengMDPI AGApplied Sciences2076-34172025-01-0115267010.3390/app15020670The Influence of Vitamin D Levels and Supplementation on the Treatment of Patients Affected by MRONJFilip Michalak0Marzena Dominiak1Jan Kiryk2Paweł Popecki3Dominik Kubicki4Jacek Matys5Kinga Grzech-Leśniak6Dental Surgery Department, Wroclaw Medical University, Krakowska St. 26, 50-425 Wroclaw, PolandDental Surgery Department, Wroclaw Medical University, Krakowska St. 26, 50-425 Wroclaw, PolandDental Surgery Department, Wroclaw Medical University, Krakowska St. 26, 50-425 Wroclaw, PolandDental Surgery Department, Wroclaw Medical University, Krakowska St. 26, 50-425 Wroclaw, PolandClinical Department of Pediatric Nephrology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, PolandDental Surgery Department, Wroclaw Medical University, Krakowska St. 26, 50-425 Wroclaw, PolandDental Surgery Department, Wroclaw Medical University, Krakowska St. 26, 50-425 Wroclaw, Poland<b>Background:</b> Advancements in pharmacology have led to the introduction of novel antiresorptive and antiangiogenic drugs, which are associated with the side effect of medication-related osteonecrosis of the jaw (MRONJ). The aim of this study was to evaluate the impact of different blood levels of vitamin D on the course of treatment, as well as the role of vitamin D supplementation during the treatment of primary diseases involving bisphosphonates or denosumab. Methods: The clinical trial involved 64 patients diagnosed with medication-related osteonecrosis of the jaw (MRONJ) treated at the Department of Oral Surgery. Participants underwent baseline panoramic radiographs and Cone Beam Computed Tomography (CBCT) scans, with MRONJ severity categorized according to the AAOMS classification. This study included two groups: 37 patients (n = 37) in the experimental group received high-dose vitamin D supplementation (10,000 IU/day for 4 weeks, followed by a maintenance dose of 5000 IU/day), while 27 patients (n = 27) in the control group received no supplementation. Vitamin D levels were measured at baseline, 3 months, and 6 months, and the relationship between vitamin D supplementation and clinical outcomes, including MRONJ risk and healing, was evaluated. All participants received an antibiotic regimen pre- and post-surgery. Pain intensity was assessed at multiple time points using the Visual Analog Scale (VAS). Results: This study showed significant increases in serum vitamin D levels in the experimental group at 3 and 6 months (<i>p</i> < 0.05). In the prophylactic context, Vitamin D supplementation prior to or during tooth extraction reduced the risk of developing severe MJRON (OR = 68.57; <i>p</i> < 0.001). In the therapeutic context among patients with established MJRON, vitamin D supplementation did not significantly predict postoperative complications (<i>p</i> = 0.079) or complete healing (OR = 2.34; <i>p</i> = 0.051). However, overall healing rates were somewhat higher in the supplemented group, though they did not reach statistical significance. Antibiotic protection uses also reduced the need for further treatment (OR = 6.20; <i>p</i> < 0.001). Conclusions: Prophylactic high-dose vitamin D supplementation may help prevent severe MRONJ in at-risk patients undergoing tooth extraction. Once MRONJ is established, however, vitamin D alone may not significantly alter immediate postoperative outcomes, although further research is needed to clarify its potential adjunctive benefits.https://www.mdpi.com/2076-3417/15/2/670ARDbisphosphonatesdenosumabMRONJosteonecrosisvitamin D |
| spellingShingle | Filip Michalak Marzena Dominiak Jan Kiryk Paweł Popecki Dominik Kubicki Jacek Matys Kinga Grzech-Leśniak The Influence of Vitamin D Levels and Supplementation on the Treatment of Patients Affected by MRONJ Applied Sciences ARD bisphosphonates denosumab MRONJ osteonecrosis vitamin D |
| title | The Influence of Vitamin D Levels and Supplementation on the Treatment of Patients Affected by MRONJ |
| title_full | The Influence of Vitamin D Levels and Supplementation on the Treatment of Patients Affected by MRONJ |
| title_fullStr | The Influence of Vitamin D Levels and Supplementation on the Treatment of Patients Affected by MRONJ |
| title_full_unstemmed | The Influence of Vitamin D Levels and Supplementation on the Treatment of Patients Affected by MRONJ |
| title_short | The Influence of Vitamin D Levels and Supplementation on the Treatment of Patients Affected by MRONJ |
| title_sort | influence of vitamin d levels and supplementation on the treatment of patients affected by mronj |
| topic | ARD bisphosphonates denosumab MRONJ osteonecrosis vitamin D |
| url | https://www.mdpi.com/2076-3417/15/2/670 |
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