Endocrine Abstracts

Introduction: MRONJ is defined as exposed bone in the maxillofacial region that persists after eight weeks in patients treated with antiresorptive or anti-angiogenic drugs, without previous radiotherapy. The estimated United Kingdom incidence of MRONJ in osteoporosis patients is 0.01-0.1% ⁽¹⁾. MRONJ can cause severe disfigurement, speech and feeding difficulties. We aim to investigate MRONJ incidence and utility of dental screening in patients receiving Zoledronate or Denosumab within the NHS Lanarkshire osteoporosis service.

Methodology: 440 patients referred for PADS (2012-2018) were identified for retrospective data collection using electronic health and dental records and analysed using IBM SPSS 26.

Results: 78.6% of patients had no delays in therapy commencement (n = 346). The median time from therapy decision to treatment administration following PADS was 110 days (23-1069 days). Delays were due to dental non-attendance 4.3% (n = 19), dental treatment completion (7.0% n = 31) and secondary care referrals (2.7 % n = 12). In 7.4 % (n = 32) of patients, antiresorptive therapy was not started due to non-attendance for dental treatment. During the follow-up period, two patients developed MRONJ. One patient was excluded as they had concurrent radiotherapy for tonsillar cancer. The incidence of MRONJ is therefore 0.002% (1 in 440) over a period of 7 years. 22.5% of the cohort were not registered with a dentist, triggering a public dental service referral. In this subset, 130 dental extractions, 52 periodontal treatments and 112 dentures manufactures were carried out.

Conclusions: NHS Lanarkshire has a high deprivation level⁽²⁾ and despite 99.4% of adults being registered with an NHS dentist⁽³⁾, dental treatment need is high which increases MRONJ risk. Our introduction of PADS did not delay antiresorptive treatment for most patients and triggered 294 dental treatments in patients not registered with a dentist. In conclusion, PADS has improved oral health and achieved a lower incidence of MRONJ than the national average.