083. TOWARDS CONSENSUS GUIDELINES FOR THE PREVENTION OF MEDICATION-RELATED OSTEONECROSIS OF THE JAW: SURVEY RESULTS AMONG OSTEOPOROSIS CLINICIANS ATTENDING THE BRITISH SOCIETY FOR RHEUMATOLOGY ANNUAL CONFERENCE 2016

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) is defined as persistent non-healing exposed dental bone in a patient who has been exposed to an implicated bone-active medication. The patient must also not have metastatic disease or received therapeutic irradiation. The Medicines and Healthcare Products Regulatory Agency (MHRA) advises that all patients with cancer should have a dental check-up before commencing bone-active medications but those commencing for other indications (such as osteoporosis) should undergo additional dental examination only if they have dental problems or other risk factors for MRONJ. Our previous work highlighted the experiences of dental practitioners and rheumatologists in the South-west of England and the rarity of jaw osteonecrosis in the osteoporosis community. We decided to survey clinicians attending the BSR annual conference osteoporosis special interest group (SIG) to explore their experience with MRONJ. Method(s): A questionnaire was distributed to attendees of the osteoporosis SIG at the BSR annual conference in April 2016. This explored areas of practice, clinician grade, the number of patients on bone-active medications seen, experience with MRONJ (encounters and management), the existence of local guidelines and the advice given to patients on starting bone prophylaxis. Result(s): 29 osteoporosis clinicians completed the questionnaire, of which 24 (83%) work in the UK. Despite targeting osteoporosis specialists, 14 (48%) respondents had never seen a case of MRONJ. 64% of those who reported seeing more than 40 patients per month on bone-active medications had encountered a case of MRONJ. Only 7 clinicians (24%) routinely discuss MRONJ on commencing boneactive medications and most [25/29 (86%)] are unaware of the existence of local or national guidelines regarding the condition. The advice given about dental screening and dental treatment while taking bone-active treatments varies widely among respondents. Less than 30 cases of MRONJ were identified by respondents and most of these gradually healed with conservative or surgical management and there were only 3 reported cases that did not heal of which one had coexistent malignancy (although some cases had been lost to follow-up or were still receiving treatment at the time of responding to the questionnaire). Conclusion(s): This survey suggests MRONJ is encountered uncommonly, even among those clinicians reviewing relatively large numbers of patients taking bone-active medications. There is a lack of consensus guidelines and practice seems to vary widely in different departments, particularly with regard to dental screening and advice given prior to dental treatment. Locally, a meeting with our dental, oncological and general practitioner colleagues resulted in a prospective database of patients referred for assessment of MRONJ along with direct access appointments to restorative dental colleagues for patients about to start IV bisphosphonates with concurrent malignancy or other significant risk factors for the development of MRONJ.