Osteonecrosis of the jaw in patients with metastatic renal carcinoma: systematic review and meta-analysis

Osteonecrosis of the jaws (ONJ) is a drug-related complication characterized by the presence of necrotic bone or fistula in the maxillofacial region for over eight weeks in patients treated with anti-resorptive and/or anti-angiogenic drugs without head and neck radiation therapy. Initially documented in cancer patients treated with bisphosphonates in 2003, the definition of ONJ has expanded to include cases associated with other drugs such as denosumab and bone-modifying agents, leading to the broader term Medication-Related Osteonecrosis of the Jaw (MRONJ). Due to their anti-osteoclastic and antiangiogenic effects, these drugs are used to treat bone metastases, multiple myeloma, and osteoporosis. Although effective in reducing cancer-related skeletal events, their use can lead to ONJ, causing pain and infections. This study focuses on renal cell carcinoma (RCC), which often presents with bone metastases, increasing the risk of skeletal events. The systematic literature review evaluated the incidence of MRONJ in patients with metastatic RCC treated with bisphosphonates and other drugs. Retrospective studies were analyzed to identify risk factors for ONJ, including drug type, administration, treatment duration, and local or systemic conditions. Out of 130 initial articles, six retrospective studies were included in the review, highlighting an overall incidence of ONJ of 1.3% in patients with metastatic RCC. These findings underscore the importance of carefully monitoring patients undergoing BMA treatment to prevent and effectively manage ONJ.