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Landi L, Leali PT, Barbato L, Carrassi AM, Discepoli N, Muti PCM, Oteri G, Rigoni M, Romanini E, Ruggiero C, Tarantino U, Varoni E, Sforza NM, Brandi ML. Anti-resorptive therapy in the osteometabolic patient affected by periodontitis. A joint position paper of the Italian Society of Orthopaedics and Traumatology (SIOT) and the Italian Society of Periodontology and Implantology (SIdP). J Orthop Traumatol 2023; 24:36. [PMID: 37453950 DOI: 10.1186/s10195-023-00713-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023] Open
Abstract
This joint report from the Italian Society of Orthopaedics and Traumatology (SIOT) and the Italian Society of Periodontology and Implantology (SIdP) aims for a consensus around the scientific rationale and clinical strategy for the management of osteoporotic patients affected by periodontitis who are undergoing anti-resorptive (AR) therapy to manage the risk of the occurrence of a medication-related osteonecrosis of the jaws (MRONJ). Osteoporosis and periodontitis are chronic diseases with a high prevalence in aging patients, and they share some of the same pathogenetic mechanisms based upon inflammation. Available evidence shows the relationship among osteoporosis, AR agents, periodontitis and implant therapy in relation to the incidence of MRONJ. Uncontrolled periodontitis may lead to tooth loss and to the need to replace teeth with dental implants. Tooth extraction and surgical dental procedures are recognized as the main risk factors for developing MRONJ in individuals taking AR therapy for osteometabolic conditions. Although the incidence of MRONJ in osteometabolic patients taking AR therapy may be as low as 0.9%, the increasing prevalence of osteoporosis and the high prevalence of periodontitis suggest that this potential complication should not be overlooked. Good clinical practice (GCP) guidelines are proposed that aim at a more integrated approach (prescriber, dentist, periodontist and dental hygienist) in the management of periodontitis patients undergoing AR therapy for osteometabolic disorders to reduce the risk of MRONJ. Dental professional and prescribers should educate patients regarding the potential risk associated with the long-term use of AR therapy and oral health behavior.
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Affiliation(s)
- L Landi
- SIdP Panel, Via della Balduina 114, 00136, Rome, Italy.
- Private Practice Verona and Roma, Verona, Italy.
| | - P Tranquilli Leali
- SIOT Panel, Rome, Italy
- Department of Orthopedic Diseases, University of Sassari, Sassari, Italy
| | - L Barbato
- SIdP Panel, Via della Balduina 114, 00136, Rome, Italy
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - A M Carrassi
- SIdP Panel, Via della Balduina 114, 00136, Rome, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - N Discepoli
- SIdP Panel, Via della Balduina 114, 00136, Rome, Italy
- Department of Medical Biotechnologies, Unit of Periodontology, University of Siena, Siena, Italy
| | - P C M Muti
- SIdP Panel, Via della Balduina 114, 00136, Rome, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Oteri
- SIdP Panel, Via della Balduina 114, 00136, Rome, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - M Rigoni
- SIOT Panel, Rome, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - E Romanini
- SIOT Panel, Rome, Italy
- RomaPro, Polo Sanitario San Feliciano, Rome, Italy
| | - C Ruggiero
- SIOT Panel, Rome, Italy
- Department of Medicine and Surgery, Gerontology and Geriatric Section, University of Perugia, Perugia, Italy
| | - U Tarantino
- SIOT Panel, Rome, Italy
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - E Varoni
- SIdP Panel, Via della Balduina 114, 00136, Rome, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - N M Sforza
- SIdP Panel, Via della Balduina 114, 00136, Rome, Italy
- Private Practice Bologna, Bologna, Italy
| | - M L Brandi
- SIOT Panel, Rome, Italy.
- Osservatorio Fratture da Fragilità, Via San Gallo 123, 50100, Florence, Italy.
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