What happens to the BRONJ patients when re-classified according to the novel SICMFSIPMO recommendations? Our experience

Background. Since 2009, according to the American Association of Oral and Maxillofacial Surgeons staging system (AAOMS-SS), Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ) has been defined by the presence of bone exposition; in absence of this condition, patients presenting other unspecific clinical and/or radiological signs of disease were classified into the “stage 0”. In 2012, the Italian Society of Maxillo-Facial Surgery (SICMF) and the Italian Society of Oral Pathology and Medicine (SIPMO) redefined BRONJ, as an adverse drug event, with several clinical forms (exposed and not-exposed), and updated the staging system, abolishing the stage 0. Aim of this study was to re-classify BRONJ cases in order to define the most adequate managements accordingly. Method. A retrospective database analysis of BRONJ cases observed at the Sector of Oral Medicine-University of Palermo from 2005 to 2012 was performed. A total of 93 patients (M: 27; F: 66; mean age ± SD 69 ±7yy), previously classified according 2009 AAOMS-SS (stages 0, 1, 2 and 3), were reclassified according 2012 SICMF-SIPMO staging system (SS-SS) [stage 1 (focal); 2 (diffuse) and 3 complicated)]. Results. In our sample, BRONJ AAOMS staging was the following: “stage 0” 16/93 (17.2%); “stage 1” 16/93 (17.2%); “stage 2” 48/93 (51.6%) and “stage 3” 13/93 (14%). On the basis of the novel SS-SS, distribution of cases were: “stage 1” 33/93 (35.5%); “stage 2” 41/93 (44.1%) and “stage 3” 19/93 (20.4%). Of the 16 cases “stage 0”, 6/16 (37.5%) has become “stage 1”; 6/16 (37.5%) “stage 2” and 4/16 (25%) “stage 3”, respectively. Conclusion. After the re-classification, a large quote of BRONJ cases, previously underestimated as stage 0, were properly diagnosed as diffuse-complicated cases. According to our experience, the updated staging system provide important clinical benefits, such as anticipating BRONJ diagnosis, performing therapies earlier and adequate to the correct staging, in order to increase treatment effectiveness.