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120:Necessity of Drug Holidays for Patients Treated with Bisphosphonates in ARONJ Prevention[AAOM2021]
Poster Title: 120:Necessity of Drug Holidays for Patients Treated with Bisphosphonates in ARONJ Prevention[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Taku Kimura, Takuya Asaka, Jun Sato, Chiharu Satoh, Yoshimasa Kitagawa
Affiliations: Oral Diagnosis and Medicine, Division of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
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Poster Information
Abstract: Objectives

Recently, it has been controversial whether taking drug holidays of bisphosphonates before tooth extraction is effective or not to prevent the onset of anti-resorptive agents-related osteonecrosis of jaws (ARONJ). For the management of patients taking oral bisphosphonates (BP), the position paper was reported by the Allied Task Force Committee of the Japanese Society for Bone and Mineral Research in 2016. Since it is unclear that the relation between taking drug holidays and the onset of ARONJ, we cannot strongly recommend patients take drug holidays before tooth extraction. The aim of this study was to examine the relationship between the taking drug holidays of BP and the onset of ARONJ.


Between February 2012 and August 2018, 172 patients with a history of being treated by oral bisphosphonates underwent tooth extraction in our department. We performed a multiple logistic regression analysis to investigate the relationships between the onset of ARONJ and its risk factors including sex, age, primary disease, the sites and types of tooth extraction, primary wound closure, and drug holiday.


Drug holidays was performed in 128 patients (74%), and the rate was declining (50%) in 2018. Of 128 patients, 8 patients (6.3%) developed ARONJ (stage 0: 1 patient and stage 1: 7 patients) whereas 1 patient (2.3%) developed ARONJ (stage1) in a group without drug holidays. Statistical analysis showed no significant difference between the 2 groups in the prevention of ARONJ in terms of drug holidays (P = 0.38). Every ARONJ patient was successfully controlled by minimally invasive surgical procedure.


The occurrence of ARONJ in our department (9/172, 5.2%) was higher than previous reports. Most of the patients had some high-risk factors like taking oral bisphosphonates in a long term or receiving steroid therapy, which might be related to our result. However, every ARONJ patient was able to be well-controlled by minimally invasive surgical procedure. Since taking drug holidays did not result in the prevention of ARONJ in our study, we need to consider carefully whether drug holidays are really necessary before tooth extraction.
Summary: The aim of this study was to examine the relationship between the taking drug holidays of BP and the onset of ARONJ.

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