How often does osteonecrosis of the jaw (ONJ) occur in myeloma patients? The studies I’ve read document occurrences in the single digits. My problem with those studies is that they track MM patients for only a few years.
The study linked and excerpted below tracks the use of bisphosphonates (zometa, acedia, etc,) and denosumab for 10 years. Yes, the study is about the long-term use of bone strengthening drugs for prostate cancer patients with metastatic cancer but I’m using it to bring attention to the problems myeloma patients have with osteonecrosis of the jaw.
According to research between 1-10% of myeloma patients develop ONJ. I think that percentage is accurate if the MM patient is on bone-modifying agents (BMA) for only a year or two.
According to the study below, if a patient is one monthly BMA’s for 5-10 years, the occurrence of ONJ skyrockets to more than 60%.
As you can see, there are many benefits of taking bone modifying agents for the newly diagnosed MM patient. My point is simply that less is more. Or I should say that the risks of BMA begin to outweigh the benefits the longer the MM patient takes BMA.
And remember that there are a host of nutritional supplements- vitamin d, magnesium, calcium, etc. shown to enhance bone health.
Are you a newly diagnosed MM patient? To learn more about both conventional and non-conventional MM therapies email me at David.PeopleBeatingCancer@gmail.com
“Bone-modifying agents (BMA) are extensively used in treating patients with prostate cancer with bone metastases. However, this increases the risk of medication-related osteonecrosis of the jaw (MRONJ). The safety of long-term BMA administration in clinical practice remains unclear…
The cumulative incidence rates of severe MRONJ were 3%, 7%, 21%, and 51% at 1, 2, 5, and 10 years, respectively (Fig. 3A)..
This study focused on the cumulative incidence of MRONJ with long-term BMA use in prostate cancer patients with bone metastases. The cumulative incidence of MRONJ was approximately one-quarter at 5 years, but at 10 years, more than half of the patients had developed the disease.
Denosumab use was the risk factor for MRONJ of any stage, whereas BMA administration at longer than one-month intervals was associated with a lower risk of MRONJ. Thus, the null hypothesis that BMA type and dosing interval do not affect the occurrence of MRONJ has been rejected…
Recently, Nakai et al.1 reported an MRONJ incidence rate of 27.5% in patients with prostate cancer and bone metastases at 5 years, which is similar to our findings. However, the incidence at 10 years remained unknown.
In this study, the 10-year cumulative incidence of MRONJ was 61%. Although the majority of MRONJ cases occurred within the first 3 years, some MRONJ cases were observed even after long-term treatment. This highlights the substantial risk associated with long-term BMA use.
The association between prolonged BMA use and an increased incidence of MRONJ has been increasingly reported10,11,24,25, making the optimal duration of BMA administration a crucial issue for the future, especially in patients with prostate cancer who undergo prolonged BMA therapy…
Although denosumab is more effective than zoledronic acid in reducing the incidence of SREs, an analysis of eight RCTs found a significantly higher incidence of MRONJ with denosumab than with zoledronic acid administration7.
The incidence of MRONJ with denosumab use ranged from
- 0.5–2.1% at 1 year,
- 1.1–3.0% at 2 years,
- and 1.3–3.2% at 3 years7.
Long-term denosumab use has been associated with an increased risk of MRONJ; however, observational studies on denosumab treatment beyond 3 years are limited. Our study identified denosumab use as an independent risk factor for MRONJ development compared with zoledronic acid use, even during long-term follow-up. The use of denosumab is expected to increase in the future because of its potential to mitigate nephrotoxicity and its non-requirement for intravenous infusion…
Conclusion
In conclusion, this study revealed a significantly increased cumulative incidence of MRONJ in patients with prostate cancer and bone metastases after long-term BMA treatment.
Denosumab use was identified as an independent risk factor for MRONJ, and BMA use at intervals longer than one month was associated with a lower risk of MRONJ. Diabetes mellitus and numerous bone metastases were also identified as risk factors for severe MRONJ. These findings advocate for considering extended BMA dosing intervals in patients with prostate cancer with bone metastases undergoing long-term therapy. Furthermore, the recognition of risk factors for severe MRONJ underscores the importance of early detection in patients with diabetes mellitus and multiple bone metastases as a preventive measure.”
