New research by PhD candidate Fredrik Hallmer shows that medication related osteonecrosis of the jaw can be treated surgically.

Bisphosphonates and denosumab are two pharmaceuticals that are given to patients with skeletal weakness and patients with breast or prostate cancer that has spread to the bone. The medication is used to preserve bone strength and reduce the risk of fractures but can also cause a serious side-affect: osteonecrosis of the jaw. Osteonecrosis is a disease in which the cells of the jawbone begin to die.

Basically, you cut out the dead bone and sow the mucosa back together. In most cases it heals without any sign of infection or pain.

Fredrik Hallmer

Hallmer, a maxillofacial surgeon and PhD candidate at Malmö University, has researched the risk factors and treatment outcomes associated with osteonecrosis. The disease can be incredibly painful, leading to infections and loss of teeth. The study includes 55 patients diagnosed between 2012 and 2015, all of them treated by Hallmer himself.

“It used to be that treatment was avoided for fear of worsening the damage,” says Hallmer, who treated patients by removing dead bone tissue.

“Basically, you cut out the dead bone and sow the mucosa back together. In most cases it heals without any sign of infection or pain.”

Hallmer took bone samples from 18 patients, finding bacteria in the bone lesions.

“This suggests that it is a combination of medication and periodontal infection that causes the disease.”

His study also shows that osteonecrosis of the jaw is three times more likely when patients are treated with denosumab compared to using bisphosphonates.

“Of course, it’s important to choose the best medicine for treatment, that’s the first priority,” Hallmer says.

A further finding is that medication relation osteonecrosis of the jaw is higher among patients with diabetes. Smoking and chemotherapy were, however, not associated with increased risk of the disease. Treatment with corticosteroids, which were previously thought to increase the risk of the disease, actually proved to have a positive effect.

The results of Hallmer’s study offers oncologists the opportunity to develop improved guidelines on cancer treatment that will hopefully include measures on how to prevent new cases of osteonecrosis of the jaw from happening.

“When you know that patients are in the risk zone, it’s much easier to prevent osteonecrosis,” Hallmer adds.

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