Multidisciplinary prevention of medication related osteonecrosis of the jaw

Abstract

Background: Medication related osteonecrosis of the jaw (MRONJ), is a rare adverse effect of anti-resorptive or anti-angiogenic drug therapy that can cause significant morbidity; commonly prescribed drugs, such as bisphosphonates, used to treat a variety of cancers and osteoporosis have been associated with MRONJ (1). A multidisciplinary approach to the promotion and prioritisation of preventative strategies to ensure patients are dentally fit prior to the prescription of implicated medications is recommended; current evidence suggests that patients have limited knowledge relating to MRONJ and that preventative strategies are rarely implemented (2,3,4). Objective: To explore the impact of MRONJ on quality of life and to explore the attitudes and perceptions of patients towards the multidisciplinary approach to the prevention of the condition. Method: Using a Grounded Theory approach and integrating a process of constant comparison in the iterative enrichment of data sets, semi-structured interviews were undertaken, transcribed and analysed using Ritchie and Spencer’s (2002) Framework Analysis(7). 23 patients; 6 patients with MRONJ, 13 patients prescribed a bisphosphonate and 4 patients with osteoporosis not currently prescribed any medication were recruited from primary care general medical practices and secondary care dental services in England. Salient themes were identified and related back to extant literature in the field. Results: Five salient and inter-related themes emerged: (1) quality of life, indicating the physical, psychological and social impact of MRONJ; (2) limited knowledge, indicating limited awareness of the condition, risk factors and preventative strategies; (3) patient specific, referring to the complexity of patients, polypharmacy, prioritising aspects of care and personal responsibility; (4) inter-professional management, indicating a perceived organisational hierarchy, professional roles and responsibilities, articulation of risk and communication; (5) wider context, indicating potential demands on NHS resources, and barriers to dental care. Conclusions: MRONJ has a significant impact on quality of life yet appropriate preventative education is not apparent. Effective inter-professional patient education and prevention to mitigate against the risk of developing MRONJ is required