[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-56160-en":3,"doc-seo-56160-105":29,"detail-sidebar-cat-0-en-105":95},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":13,"seo_description":14,"update_tm":27,"read_time":28},56160,1099513958762,"Logic","https://ap-avatar.wpscdn.com/avatar/1000023916a998db790?x-image-process=image/resize,m_fixed,w_180,h_180&k=1782109480056885918",7,"Healthcare","The Risk of Medication-Related Osteonecrosis of the Jaw in Children: Guidance for Antiresorptive Use in Pediatric Patients","Study guidance for pediatric antiresorptive therapy focuses on medication-related osteonecrosis of the jaw (ONJ), a complication seen in adults with drugs such as denosumab and bisphosphonates. A retrospective cohort from 2007–2023 evaluated pediatric patients treated with intravenous bisphosphonates or denosumab and assessed ONJ frequency, risk factors, and related side effects. Among 178 subjects, no ONJ cases occurred. Denosumab showed higher rates of hypercalcemia and severe bone pain, supporting bisphosphonate first-line use in children with denosumab reserved for refractory situations.","PATHOLOGY  \nThe Risk of Medication-Related   Osteonecrosis of the Jaw in Children: Guidance for Antiresorptive Use in Pediatric Patients  \nSasha Lasky,*y Tayla Moshal,*y Pasha Shakoori, MD, DDS, zIdean Roohani, *y MarahJolibois, MS,* Simon Youn, MD, DDS,yx Mark M. Urata, MD, DDS, *z and Jeffrey A. Hammoudeh, MD, DDS *z  \nBackground: Antiresorptive targeted cancer therapies, such as denosumab and bisphosphonates, are used in adults, but their application in pediatric cancer is more recent. Side effects such as osteonecrosis of the jaw (ONJ) observed in adults have curtailed use of these medications in the pediatric population. Purpose: This study assesses the frequency of ONJ, other side effects, and the indications for use of denosumab versus bisphosphonates in pediatric subjects.  \nStudy Design, Setting, Sample: A retrospective cohort study of pediatric subjects who underwent bisphosphonate or denosumab therapy at our institution from 2007-2023 was conducted. Subjects aged $ 18 years at therapy initiation were excluded.  \nIndependent Variable: The independent variable was antiresorptive therapy divided into 2 groups, treatment with intravenous bisphosphonates or denosumab.  \nMain Outcome Variable(s): Primary outcomes were development of bisphosphonate-related and denosumab-related ONJ. Secondary outcomes included additional side effects.  \nCovariates: ONJ risk factors, subject demographics, indications for use, timing, duration, and cumulative dose of antiresorptive therapy were abstracted.  \nAnalyses: Univariate and bivariate statistics were computed to describe the sample and measure associations between antiresorptive therapy and outcomes. P values \u003C .05 conferred statistical significance.  \nResults: The sample was composed of 178 subjects with a mean age of 11 .7 􀀂 6. 1 years. There were 14  \n(7.9%) and 164 (92.1%) subjects treated with denosumab and bisphosphonate therapies, respectively. There were 0 cases of ONJ across all subjects. The most common indication for treatment was adjuvant targeted therapy for aggressive tumors and malignancy (39.3%) followed by osteoporosis (14.6%) . Subjects treated with denosumab had higher frequencies of hypercalcemia and severe bone pain than subjects treated with bisphosphonates, 28 .6% versus 1 .2%(P \u003C .001) and 14 .3% versus 0 .00%(P \u003C .001), respectively.  \nConclusion and Relevance: While invasive dental procedures are ideally performed before antiresorptive treatment, our data suggest that bisphosphonates may be used safely in the pediatric population with low concern for ONJ. Our data also demonstrated bisphosphonates may have a more tolerable side effect  \n*Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, California.  \nyKeck School of Medicine, University of Southern California, Los Angeles, California.  \nzDivision of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California.  \nxHerman Ostrow School of Dentistry, University of Southern California, Los Angeles, California.  \nConflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.  \nAddress correspondence andreprint requests to Dr Hammoudeh: Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033; [e-mail: JHammoudeh@chla.usc.edu](e-mail: JHammoudeh@chla.usc.edu)  \nReceived March 16 2024 Accepted June 7 2024  \n􀀁 2024 American Association of Oral and Maxillofacial Surgeons 0278-2391/24/00540-8  \n[https://doi.org/10.1016/j.joms.2024.06.162](https://doi.org/10.1016/j.joms.2024.06.162)  \n1286 RISK OF MRONJ IN CHILDREN  \nprofile than denosumab. If the perceived benefits are similar, we recommend using bisphosphonates as first-line therapy in children while reserving denosumab for refractory cases. Future studies will help determine long-term side effects and differences in efficacies of these medications.  \n􀀁 2","cbCaipQHgLbntbOE","https://ap.wps.com/l/cbCaipQHgLbntbOE","pdf",513666,1,10,"English","en",105,"# Background\n# Purpose\n# Study Design and Methods\n## Variables and Analyses\n# Results\n# Conclusion and Clinical Relevance\n# Medication Context and MRONJ Definition","[{\"question\":\"What is the study’s primary objective regarding antiresorptive medications in children?\",\"answer\":\"To assess the frequency of medication-related osteonecrosis of the jaw (ONJ) and other side effects, and to compare indications for denosumab versus bisphosphonates in pediatric patients.\"},{\"question\":\"How was the study conducted and who was included?\",\"answer\":\"A retrospective cohort study reviewed pediatric subjects who received bisphosphonate or denosumab therapy from 2007–2023 at the authors’ institution, excluding subjects aged 18 years or older at therapy initiation.\"},{\"question\":\"What were the main findings about ONJ incidence in the pediatric cohort?\",\"answer\":\"No ONJ cases were observed across all 178 subjects treated with either denosumab or bisphosphonates.\"},{\"question\":\"How did side effects compare between denosumab and bisphosphonates?\",\"answer\":\"Denosumab was associated with higher frequencies of hypercalcemia and severe bone pain compared with bisphosphonates, with statistically significant differences reported (P \\u003c .001 for both).\"}]",1783717294,25,{"code":4,"msg":30,"data":31},"ok",{"site_id":24,"language":23,"slug":32,"title":13,"keywords":33,"description":14,"schema_data":34,"social_meta":90,"head_meta":92,"extra_data":94,"updated_unix":27},"the-risk-of-medication-related-osteonecrosis-of-the-jaw-in-children-guidance-for-antiresorptive-use-in-pediatric-patients","",{"@graph":35,"@context":89},[36,53,68],{"@type":37,"itemListElement":38},"BreadcrumbList",[39,43,47,50],{"item":40,"name":41,"@type":42,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":44,"name":45,"@type":42,"position":46},"https://docshare.wps.com/document/","Document",2,{"item":48,"name":12,"@type":42,"position":49},"https://docshare.wps.com/document/healthcare/",3,{"item":51,"name":13,"@type":42,"position":52},"https://docshare.wps.com/document/the-risk-of-medication-related-osteonecrosis-of-the-jaw-in-children-guidance-for-antiresorptive-use-in-pediatric-patients/56160/",4,{"url":51,"name":13,"@type":54,"author":55,"headline":13,"publisher":57,"fileFormat":60,"inLanguage":23,"description":14,"dateModified":61,"datePublished":62,"encodingFormat":60,"isAccessibleForFree":63,"interactionStatistic":64},"DigitalDocument",{"name":9,"@type":56},"Person",{"url":40,"name":58,"@type":59},"DocShare","Organization","application/pdf","2026-07-17","2026-07-10",true,{"@type":65,"interactionType":66,"userInteractionCount":20},"InteractionCounter",{"@type":67},"ViewAction",{"@type":69,"mainEntity":70},"FAQPage",[71,77,81,85],{"name":72,"@type":73,"acceptedAnswer":74},"What is the study’s primary objective regarding antiresorptive medications in children?","Question",{"text":75,"@type":76},"To assess the frequency of medication-related osteonecrosis of the jaw (ONJ) and other side effects, and to compare indications for denosumab versus bisphosphonates in pediatric patients.","Answer",{"name":78,"@type":73,"acceptedAnswer":79},"How was the study conducted and who was included?",{"text":80,"@type":76},"A retrospective cohort study reviewed pediatric subjects who received bisphosphonate or denosumab therapy from 2007–2023 at the authors’ institution, excluding subjects aged 18 years or older at therapy initiation.",{"name":82,"@type":73,"acceptedAnswer":83},"What were the main findings about ONJ incidence in the pediatric cohort?",{"text":84,"@type":76},"No ONJ cases were observed across all 178 subjects treated with either denosumab or bisphosphonates.",{"name":86,"@type":73,"acceptedAnswer":87},"How did side effects compare between denosumab and bisphosphonates?",{"text":88,"@type":76},"Denosumab was associated with higher frequencies of hypercalcemia and severe bone pain compared with bisphosphonates, with statistically significant differences reported (P \u003C .001 for both).","https://schema.org",{"og:url":51,"og:type":91,"og:title":13,"og:site_name":58,"og:description":14},"article",{"robots":93,"canonical":51},"index,follow",{"doc_id":7,"site_id":24},{"code":4,"msg":5,"data":96},[97,101,105,109,114,119,122,127,132,135,138],{"id":20,"doc_module":4,"doc_module_name":45,"category_name":98,"show_sort_weight":99,"slug":100},"Story & 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