Medication related osteonecrosis (MRONJ) in the management of CTIBL in breast and prostate cancer patients. Joint report by SIPMO AND SIOMMMS
Background: Low-doses of bone modifying agents (LD-BMAs) compared to those used to treat bone metastases are used in breast or prostate cancer patients on adjuvant endocrine therapy to prevent Cancer Treatment Induced Bone Loss (CTIBL). Their use is associated with an increased risk of developing Me...
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Elsevier
2025-02-01
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| Series: | Journal of Bone Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2212137424001362 |
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| author | Francesco Bertoldo Cristina Eller-Vainicher Vittorio Fusco Rodolfo Mauceri Jessica Pepe Alberto Bedogni Andrea Palermo Umberto Romeo Giuseppe Guglielmi Giuseppina Campisi |
| author_facet | Francesco Bertoldo Cristina Eller-Vainicher Vittorio Fusco Rodolfo Mauceri Jessica Pepe Alberto Bedogni Andrea Palermo Umberto Romeo Giuseppe Guglielmi Giuseppina Campisi |
| author_sort | Francesco Bertoldo |
| collection | DOAJ |
| description | Background: Low-doses of bone modifying agents (LD-BMAs) compared to those used to treat bone metastases are used in breast or prostate cancer patients on adjuvant endocrine therapy to prevent Cancer Treatment Induced Bone Loss (CTIBL). Their use is associated with an increased risk of developing Medication-Related Osteonecrosis of the Jaw (MRONJ). However, there is not clarity about strategies aimed to minimize the MRONJ risk in cancer patients at different conditions as low- vs high-doses of BMA. This joint report from the Italian Societies of Oral Pathology and Medicine (SIPMO) and of Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS) aims to define the dental management of breast and prostate cancer patients with CTIBL under LD-BMAs, to reduce their risk to develop MRONJ. Methods: This interdisciplinary SIPMO-SIOMMMS Expert Italian Panel reviewed the available international scientific literature and developed a set of recommendations to implement strategies of MRONJ prevention in breast (BC) and prostate cancer (PC) patients undertaking LD-BMAs to prevent CTIBL. Results: The Expert Panel, after addressing some introductive topics (i.e., CTIBL and its management, pharmacology and pharmacodynamics of BMAs, definition and diagnosis of MRONJ), developed a joint report on the following five issues: a) prevention and dental management in cancer patients candidates to LD-BMAs, or under LD-BMAs; b) prophylactic drug holiday; c) MRONJ treatment; d) LD-BMAs therapeutic drug holiday; and e) restart of LD-BMA treatment after successful healing of MRONJ.Finally, ten key questions with answers were prepared and placed at the end of the document. Conclusions: Despite obvious weaknesses of the available international literature, the Expert Panel recognized the need to tailor separate MRONJ preventive approach for breast and prostate cancer patients on adjuvant endocrine therapy who begin low-dose BMA therapy to prevent CTIBL and provided this practical guidance for bone specialists and oral healthcare providers. In view of a MRONJ risk for BC and PC patients receiving low-dose BMAs, which approximates that of patients with osteoporosis and other non-malignant diseases undergoing similar treatment schedules, the SIPMO-SIOMMMS Expert Panel recognizes the need for less stringent preventive strategies than those already developed for BC or PC patients with bone metastases taking HD-BMAs. |
| format | Article |
| id | doaj-art-a3d7d33580f0466ebe016d29482aa32f |
| institution | Kabale University |
| issn | 2212-1374 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Bone Oncology |
| spelling | doaj-art-a3d7d33580f0466ebe016d29482aa32f2025-01-20T04:17:25ZengElsevierJournal of Bone Oncology2212-13742025-02-0150100656Medication related osteonecrosis (MRONJ) in the management of CTIBL in breast and prostate cancer patients. Joint report by SIPMO AND SIOMMMSFrancesco Bertoldo0Cristina Eller-Vainicher1Vittorio Fusco2Rodolfo Mauceri3Jessica Pepe4Alberto Bedogni5Andrea Palermo6Umberto Romeo7Giuseppe Guglielmi8Giuseppina Campisi9Department of Medicine, University of Verona, Verona, VR, ItalyUnit of Endocrinology Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, ItalyOncology Unit, Azienda Ospedaliera di Alessandria SS, Antonio e Biagio e Cesare Arrigo, Alessandria, AL, ItalyUnit of Oral Medicine and Dentistry for Frail Patients, Department of Rehabilitation, Fragility, and Continuity of Care, Regional Center for Research and Care of MRONJ, University Hospital Palermo, Palermo, PA, Italy; Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, PA, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, ItalyRegional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, PD, Italy; Department of Neuroscience, University of Padova, Padua, PD, ItalyUnit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy; Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Corresponding author at: Unit of Endocrinology and Diabetes, Campus Bio-Medico University, via Alvaro del Portillo 200 00128, Rome ItalyDepartment of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Roma, ItalyUnit of Radiology, Ospedale “Casa Sollievo della Sofferenza”, IRCCS, San Giovanni Rotondo, FG, ItalyUnit of Oral Medicine and Dentistry for Frail Patients, Department of Rehabilitation, Fragility, and Continuity of Care, Regional Center for Research and Care of MRONJ, University Hospital Palermo, Palermo, PA, ItalyBackground: Low-doses of bone modifying agents (LD-BMAs) compared to those used to treat bone metastases are used in breast or prostate cancer patients on adjuvant endocrine therapy to prevent Cancer Treatment Induced Bone Loss (CTIBL). Their use is associated with an increased risk of developing Medication-Related Osteonecrosis of the Jaw (MRONJ). However, there is not clarity about strategies aimed to minimize the MRONJ risk in cancer patients at different conditions as low- vs high-doses of BMA. This joint report from the Italian Societies of Oral Pathology and Medicine (SIPMO) and of Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS) aims to define the dental management of breast and prostate cancer patients with CTIBL under LD-BMAs, to reduce their risk to develop MRONJ. Methods: This interdisciplinary SIPMO-SIOMMMS Expert Italian Panel reviewed the available international scientific literature and developed a set of recommendations to implement strategies of MRONJ prevention in breast (BC) and prostate cancer (PC) patients undertaking LD-BMAs to prevent CTIBL. Results: The Expert Panel, after addressing some introductive topics (i.e., CTIBL and its management, pharmacology and pharmacodynamics of BMAs, definition and diagnosis of MRONJ), developed a joint report on the following five issues: a) prevention and dental management in cancer patients candidates to LD-BMAs, or under LD-BMAs; b) prophylactic drug holiday; c) MRONJ treatment; d) LD-BMAs therapeutic drug holiday; and e) restart of LD-BMA treatment after successful healing of MRONJ.Finally, ten key questions with answers were prepared and placed at the end of the document. Conclusions: Despite obvious weaknesses of the available international literature, the Expert Panel recognized the need to tailor separate MRONJ preventive approach for breast and prostate cancer patients on adjuvant endocrine therapy who begin low-dose BMA therapy to prevent CTIBL and provided this practical guidance for bone specialists and oral healthcare providers. In view of a MRONJ risk for BC and PC patients receiving low-dose BMAs, which approximates that of patients with osteoporosis and other non-malignant diseases undergoing similar treatment schedules, the SIPMO-SIOMMMS Expert Panel recognizes the need for less stringent preventive strategies than those already developed for BC or PC patients with bone metastases taking HD-BMAs.http://www.sciencedirect.com/science/article/pii/S2212137424001362Osteonecrosis of the jawBreast cancerProstate cancerCTIBLDenosumabBisphosphonate |
| spellingShingle | Francesco Bertoldo Cristina Eller-Vainicher Vittorio Fusco Rodolfo Mauceri Jessica Pepe Alberto Bedogni Andrea Palermo Umberto Romeo Giuseppe Guglielmi Giuseppina Campisi Medication related osteonecrosis (MRONJ) in the management of CTIBL in breast and prostate cancer patients. Joint report by SIPMO AND SIOMMMS Journal of Bone Oncology Osteonecrosis of the jaw Breast cancer Prostate cancer CTIBL Denosumab Bisphosphonate |
| title | Medication related osteonecrosis (MRONJ) in the management of CTIBL in breast and prostate cancer patients. Joint report by SIPMO AND SIOMMMS |
| title_full | Medication related osteonecrosis (MRONJ) in the management of CTIBL in breast and prostate cancer patients. Joint report by SIPMO AND SIOMMMS |
| title_fullStr | Medication related osteonecrosis (MRONJ) in the management of CTIBL in breast and prostate cancer patients. Joint report by SIPMO AND SIOMMMS |
| title_full_unstemmed | Medication related osteonecrosis (MRONJ) in the management of CTIBL in breast and prostate cancer patients. Joint report by SIPMO AND SIOMMMS |
| title_short | Medication related osteonecrosis (MRONJ) in the management of CTIBL in breast and prostate cancer patients. Joint report by SIPMO AND SIOMMMS |
| title_sort | medication related osteonecrosis mronj in the management of ctibl in breast and prostate cancer patients joint report by sipmo and siommms |
| topic | Osteonecrosis of the jaw Breast cancer Prostate cancer CTIBL Denosumab Bisphosphonate |
| url | http://www.sciencedirect.com/science/article/pii/S2212137424001362 |
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