Incidence rate of osteonecrosis of jaw after cancer treated with bisphosphonates and denosumab: A systematic review and meta-analysis

ObjectivesThis study aimed to assess the overall incidence of osteonecrosis of the jaw (ONJ) caused by bisphosphonates and denosumab when used for controlling bone cancer metastasis or as adjuvant therapy. Subjects and MethodsA systematic search of the PubMed, Embase, and Cochrane Library databases and major meetings' proceedings as of July 30, 2022, identified randomized controlled trials (RCTs) and observational trials that evaluated ONJ caused by denosumab or bisphosphonates. The total incidence and risk ratio (RR) for ONJ were calculated using a random-effects model. ResultsA total of 42 003 patients with various solid tumors reported in 23 RCTs were included. The overall ONJ incidence in cancer patients receiving denosumab or bisphosphonates was 2.08% (95% CI 1.37-2.91; p I-2 = 94.99%). Patients receiving denosumab had a higher ONJ incidence than those receiving bisphosphonates (RR 1.64, 95% CI 1.10-2.44; p I-2 = 65.4%). Subgroup analyses showed that prostate cancer patients receiving denosumab and receiving zoledronic acid had the highest ONJ incidences, 5.0% and 3.0%, respectively. The incidence of ONJ induced by different doses was also different. ConclusionsThe incidence of ONJ caused by denosumab and bisphosphonates is low, the dose of the drug and the type of cancer have certain influence on ONJ. Therefore, clinicians should use the drug reasonably to improve the quality of life of patients.

Automated summary

This study aimed to assess the incidence of osteonecrosis of the jaw (ONJ) caused by bisphosphonates and denosumab in bone cancer metastasis or adjuvant therapy. A total of 42,003 patients with various solid tumors were included. The overall incidence of ONJ in cancer patients receiving denosumab or bisphosphonates was 2.08%. Patients receiving denosumab had a higher incidence of ONJ compared to those receiving bisphosphonates. Prostate cancer patients receiving denosumab and zoledronic acid had the highest incidences of ONJ at 5.0% and 3.0%, respectively. The incidence of ONJ varied with different drug doses.