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Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
Copyright © 2021 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
Organization | Year | Country | Recommendation/Suggestion | |
---|---|---|---|---|
Patients with osteoporosis | Patients with bone metastasis | |||
American Association of Oral and Maxillofacial Surgeons [7] | 2014 | United States | BP patients receiving antiresorptive therapy for longer than 4 years and who have low fracture risk but potentially high risk for BRONJ, discontinuation of antiresorptive treatment for approximately 2 months before invasive dental treatment should be considered, in consultation with the physician. | Data are scant regarding the effect of discontinuing intravenous bisphosphonates prior to invasive dental treatments should these be necessary. |
International Task Force on Osteonecrosis of the Jaw [18] | 2015 | United States, Canada, Europe, Japan | If the bisphosphonate treatment period is more than 4 years or if there are concomitant risk factors, a drug holiday is recommended until the bone is completely healed. | Any necessary invasive dental procedure including dental extractions or implants should ideally be completed prior to initiation of BP or Dmab therapy. |
Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons [8] | 2015 | Korea | In patients with a duration of oral treatment longer than 4 years regardless of clinical risk factors or less than 4 years but with clinical risk factors, BP holiday of at least 2 to 4 months should be taken before dental treatment. | Although the necessity of a drug holiday is clear in cases of MRONJ, there is little evidence on whether a drug holiday is needed in advance for prevention. |
Japanese Allied Committee on Osteonecrosis of the Jaw [9] | 2017 | Japan | There is little clinical evidence that short-term discontinuation of BPs helps to prevent the occurrence of BRONJ resulting from invasive dental treatments. | Invasive dental treatments, if inevitable, can be conducted without a drug holiday following appropriate infection control. |
Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and American Society of Clinical Oncology (ASCO) [33] | 2019 | United States | There is insufficient evidence to support or refute the need for discontinuation of the BMA before dentoalveolar surgery. | |
Fundación Santa Fé (Bogotá, Colombia) and the Asociación Colombiana de Osteoporosis y Metabolismo Mineral (ACOMM) [60] | 2020 | Colombia |
It is neither necessary nor prudent to suspend antiresorptives before dental surgery. With denosumab, next dose administration may be postponed in order to do the procedure allowing adequate healing of soft tissue (15 days). |
It is not recommended to stop the treatment with antiresorptives. |
Italian Consensus group on ONJ (IAC-ONJ) [57] | 2020 | Italy |
Suspension of BP can be considered useful 1 week before surgery. Suspension of denosumab is not recommended. An appropriate time for invasive treatment is ideally starting 5 months after the last dose and beginning at 7 months. |
Suspension of BP can be considered useful 1 week before surgery. Last administrations of denosumab (Xgeva) can be considered three weeks before surgery. |