Prevention and screening of Osteonecrosis of Jaw (ONJ): the Alessandria experience of a multisciplinary team on a 900 patient population

Patients at risk of Osteonecrosis of the Jaw (ONJ) include mostly cancer and myeloma patients receiving antiresorptive treatments (bisphosphonates and denosumab) with/without biological agents,  but also patients with osteoporosis and rheumatologic disorders. ONJ cases were firstly diagnosed in our Hospital on 2005. Since 2006, a ONJ Multidisciplinary Team was established (including maxillofacial surgeons / dentists, oncologists, hematologists, nurses, radiologists, nuclear medicine and other medicine  specialists, data managers). Preventive (risk reduction) measures before antiresorptive treatment (dental visit, dental panoramic Rx, eventual teeth extractions, dental and denture care) have been planned, according to early recommendations and their modifications. Furthermore in the Osteonecrosis Prevention and Screening office other patients received care if : a)  ONJ was suspected after treatment for cancer and myeloma in  neighboring hospitals, or b) ONJ was suspected among osteoporosis patients in the territory by private practice dentists. More than 900 patients were visited and registered in 2006-2020 years. Cases of suspected ONJ were 127 (45 male, 82 female). Twenty-four cases were excluded by analysis due to unconfirmed diagnosis or insufficient data.  Characteristics of 103 cases of ONJ confirmed according to Italian (SIPMO-SICMF) definition and recommendations were reviewed. Disease: 40 breast cancer; 16 prostate cancer; 11 myeloma; 7 renal cell cancer; 4 lung cancer; 7 other cancers; 18 osteoporosis and other non malignant disorders. Distribution of drugs associated to ONJ (zoledronic acid, denosumab, pamidronate, alendronate, risedronate, ibandronate, clodronate, bevacizumab, sunitinib) changed along years.