Joint report SIPMO-SIOMMMS sulla MRONJ in pazienti in cura con antiriassorbitivi per prevenire la CTIBL

OBJECTIVES This joint report from the Italian Society of Oral Pathology and Medicine (SIPMO) and Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS) aims to define the dental management of breast and prostate cancer patients under low-dose bone modifying agents (LD-BMAs), to reduce their risk to develop Medication-Related Osteonecrosis of the Jaw (MRONJ). The group believes that there is no clarity to date in the prevention/treatment of MRONJ within breast and prostate cancer patient groups, particularly regarding LD-BMA therapy to prevent Cancer Treatment Induced Bone Loss (CTIBL) and the different BMA therapies employed at different stages of the cancer treatment path. To the best of the knowledge of the authors, there are no joint reports, consensus papers or position papers on this specific topic in the literature. MATERIALS AND METHODS An interdisciplinary expert Italian panel, using the data available of the literature, developed these recommendations for optimal dental management for breast and prostate cancer patients undergoing LD-BMA therapy to prevent CTIBL. RESULTS The expert panel addressed the main topics: epidemiology notes of MRONJ in cancer patients treated with LD-BMAs, CTIBL management, pharmacology and pharmacodynamics of BMA drugs, MRONJ prevention and treatment. These last two topics were organized into five sections: 1) Dental management of the cancer patient who is a candidate for or already on LD-BMA therapy; 2) Suspension of BMA drug therapy before invasive dental procedures; 3) Treatment of MRONJ; 4) Therapeutic suspension of lowdose BMA drugs in patients with MRONJ; 5) Resumption of LDBMAs after healing of MRONJ. Finally, 10 key questions with answers were processed, placed in table V. The authors provide practical guidance for the clinical management of MRONJ prevention measures for bone disease specialists, endocrinologists, and oral health professionals to encourage a multidisciplinary team rationale for the benefit of breast and prostate cancer patients at this stage of their cancer care. CONCLUSIONS Based on the available literature and expert consensus, it was possible to establish specific strategies for MRONJ prevention in these categories of cancer patients on LD-BMA therapy. These prevention measures follow the latest Italian recommendations of the Scientific Societies of Pathology and Oral Medicine (SIPMO) and Maxillofacial Surgery (SICMF), focusing and implementing the indications for patients suffering from breast or prostate cancer, in therapy with LD-BMAs. CLINICAL SIGNIFICANCE The panel recognized the need to tailor MRONJ preventive approaches, less stringent for patients with breast or prostate cancer when starting low-dose AR therapies to prevent CTIBL, and to define specific more stringent measures, only when these patients switch to high-dose BMA therapies.