• Yoshiyuki Kashiwagi Department of Nursing, Sagamidai Hospital, Japan




Purpose: The aim of this study is to analyze predictive factors of ARONJ and the purpose is to examine intervention methods to prevent ARONJ.

Methods: This study is a case control study. Regarding the diagnosis of ARONJ, since the research target hospital did not have dentistry or oral surgery, the patients diagnosed with ARONJ was defined at other dental clinics as a case group. Risk factors include age, gender (male and female), ECOG performance status, cancer type, chemotherapy combination status, diabetes history, smoking and drinking history, number of oral cares per day, denture usage, medications, medications Period, hormone therapy, and blood tests (total protein, albumin, calcium, neutrophils). The Chi-square test and t-test were used to determine significant relation between variables.

Results: According to the results of univariate analysis of ARONJ, calcium (p=0.015), history of smoking (p=0.006), the number of oral care per day (p=0.013) and diabetes (0.023) have significant differences with ARONJ.

Conclusion: This study suggests that daily life factors such as oral care and physical factors such as smoking history and diabetes were predictors. This result suggests that mandibular dentures are more likely to cause denture ulcers, leading to ARONJ. Nurses need to detect risk factors early, continuously monitor the oral cavity and promote oral care.


ARONJ, Bisphosphonate, Anti-RANKL Monoclonal Antibody Drug, Oral Care


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Coates, A. (2011). Primary Therapy of Early Breast Cancer 12th International Conference St. Gallen, Switzerland, 16–19 March 2011.

Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., Parkin, D.M., Forman, D., & Bray, F. (2015). Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer, 136(5), E359-E386. https://doi.org/10.1002/ijc.29210

Force, A. T. (2007). Advisory Task Force on Bisphosphonate-Related Osteonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons: American Associaaton of Oral and Maxillofacial Syrgeons position paper on bisphosphonate-related osteonecrosi of the jaws. Journal of Oral and Maxillofacial Surgery, 65, 369-376.

Khamaisi, M., Regev, E., Yarom, N., Avni, B., Leitersdorf, E., Raz, I., & Elad, S. (2007). Possible association between diabetes and bisphosphonate-related jaw osteonecrosis. The Journal of Clinical Endocrinology & Metabolism, 92(3), 1172-1175. https://doi.org/10.1210/jc.2006-2036

Matsuo, A., Chiba, H., Hamada, H., Takahashi, H., Hiroaki, T., Hiroshi, K., & Norio, K. (2008). The early detection of osteonecrosis of the jaws associated with the use of bisphosphonates. The Japanese Stomatological Society, 57(4), 389–396.

Ministry of Health, Labor and Welfare (May 2009). http://www.mhlw.go.jp/topics/2006/11/dl/tp1122-1l01.pdf

Miura, Y., Theriault, R. L., Naito, Y., Suyama, K., Shimomura, A., Iwatani, T., Miura, D., Kawabata, H., Kumada, H., & Takano, T. (2013). The safety of chemotherapy for breast cancer patients with hepatitis C virus infection. Journal of Cancer, 4(6), 519.

Morag, Y., Morag-Hezroni, M., Jamadar, D. A., Ward, B. B., Jacobson, J. A., Zwetchkenbaum, S. R., & Helman, J. (2009). Bisphosphonate-related osteonecrosis of the jaw: a pictorial review. Radiographics, 29(7), 1971-1984. https://doi.org/10.1148/rg.297095050

Shibahara, T., Morikawa, T., Yago, K., Kishimoto, H., Imai, Y., & Kurita, K. (2018). National survey on bisphosphonate-related osteonecrosis of the jaws in Japan. Journal of Oral and Maxillofacial Surgery, 76(10), 2105-2112. https://doi.org/10.1016/j.joms.2018.04.009

Shibata, H., Kato, S., Sekine, I., Abe, K., Araki, N., Iguchi, H., ... & Yoshida, M. (2016). Diagnosis and treatment of bone metastasis: comprehensive guideline of the Japanese Society of Medical Oncology, Japanese orthopedic association, Japanese Urological Association, and Japanese Society for Radiation Oncology. ESMO Open, 1(2), e000037. https://doi.org/10.1136/esmoopen-2016-000037

Shimahara, M., Ariyoshi, Y., Imai, Y., Mizuki, H., Shimada, J., Furusawa, K., Morita, S., & Ueyama, Y. (2007). A survey of bisphosphonate-related osteomyelitis/osteonecrosis of the jaws. Japanese Journal of Oral and Maxillofacial Surgery, 53(10), 594-602. https://doi.org/10.5794/jjoms.53.594

Tanaka, N., Kishimoto, H., Takaoka, K., HashitanI, S., Sakurai, K., & Urade, M. (2007). Two cases of bisphosphonate-associated osteonecrosis of the mandible. Japanese Journal of Oral and Maxillofacial Surgery, 53(6), 392-396. https://doi.org/10.5794/jjoms.53.392

Tateishi, Y., Ohno, S., Ueta, E., & Yamamoto, T. (2008). A case of osteonecrosis of the maxilla induced by a bisphosphonate. Japanese Journal of Oral and Maxillofacial Surgery, 54(3), 155-159. https://doi.org/10.5794/jjoms.54.155

Urade, M. (2010). Present condition of occurrence of osteonecrosis of the jaws related to bisphosphonate therapy. Nippon Koukugekagaku Zasshi, 56, 294-297.

Urade, M., Tanaka, N., Furusawa, K., Shimada, J., Shibata, T., Kirita, T., Yamamoto, T., Ikebe, T., Kitagawa, Y., & Fukuta, J. (2011). Nationwide survey for bisphosphonate-related osteonecrosis of the jaws in Japan. Journal of Oral and Maxillofacial Surgery, 69(11), e364-e371. https://doi.org/10.1016/j.joms.2011.03.051

Yamaguchi, K., Takata, Y., Oizumi, T., Kurihara, J., Koeda, S., & Kawamura, H. (2008). A case of mandibular osteonecrosis possibly associated with a bisphosphonate consideration of underlying mechanisms and prevention. Japanese Journal of Oral and Maxillofacial Surgery, 54(11), 602-606. https://doi.org/10.5794/jjoms.54.602

Yokomizo, Y., Toyofuku, S., Koga, M., Tsuyama, H., Iwamoto, O., & Kusukawa, J. (2009). A case of extensive osteonecrosis on the maxilla caused by tooth extraction under chemotherapy. Journal of the Japanese Stomatological Society, 58(2), 56-63. https://doi.org/10.11277/stomatology.58.56

Yoneda, T., Hagino, H., Sugimoto, T., Ohta, H., Takahashi, S., Soen, S., Taguchi, A., Toyosawa, S., Nagata, T., & Urade, M. (2010). Bisphosphonate-related osteonecrosis of the jaw: position paper from the allied task force committee of Japanese society for bone and mineral research, Japan osteoporosis society, Japanese society of periodontology, Japanese society for oral and maxillofacial radiology, and Japanese society of oral and maxillofacial surgeons. Journal of Bone and Mineral Metabolism, 28(4), 365-383. https://doi.org/10.1007/s00774-010-0162-7



How to Cite

Yoshiyuki Kashiwagi. (2022). A RETROSPECTIVE ANALYSIS OF PREDICTORS OF ANTI-RESORPTIVE AGENTS-RELATED OSTEONECROSIS OF THE JAW (ARONJ) IN GENERAL HOSPITALS. The Malaysian Journal of Nursing (MJN), 13(3), 53-57. https://doi.org/10.31674/mjn.2022.v13i03.008