Table 1.
Guidelines/Position paper recommendations regarding high-dose antiresorptive drug holidays.
| Guideline/Position paper | Country | Year | Recommendations regarding high-dose antiresorptive drug holidays |
|---|---|---|---|
| Canadian Consensus of Practice Guidelines for Bisphosphonate Associated Osteonecrosis of the Jaw [7] | Canada | 2008 | Urgent invasive oral surgery: Discontinuation of BP therapy during healing period, if the medical conditions permits. Non-emergent procedure: BP drugs holiday for 3 to 6 months prior to oral surgery and until complete healing. |
| Osteonecrosis of the jaw complicating bisphosphonate treatment for bone disease in multiple myeloma: an overview with recommendations for prevention and treatment [8] | Australia | 2009 | If the patient's risk of skeletal-related events is low or intermediate: BP cessation for 2–3 months before extraction until complete healing. |
| The use of bisphosphonates in multiple myeloma: recommendations of an expert panel on behalf of the European Myeloma Network [16] | Europe | 2009 | Temporary suspension of BP treatment should be considered if invasive dental procedures are necessary, but any decision to suspend BP treatment should be considered on a case-by-case basis. |
| Management of patients at risk of bisphosphonate osteonecrosis in maxillofacial surgery units in the UK [17] | UK | 2009 | The use of BPs must be discussed with the prescribing physician. If continued BP use, any surgical treatment should be undertaken with at least a 2 weeks gap before the next treatment. |
| Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteonecrosis. Executive summary of recommendations from the American Dental Association Council on Scientific Affairs [9] | USA | 2011 | Drug holiday from AR drug therapy, or waiting periods before performing dental treatment, for prevention of MRONJ. |
| Guidelines for supportive care in multiple myeloma 2011 [10] | UK | 2011 | If the patient's fracture risks and disease status permits, it seems reasonable to stop the AR treatment and not recommence treatment until healing has occured. |
| Medication-Related Osteonecrosis of the Jaw - 2014 Update [1] | USA | 2014 | BP discontinuation prior to oral surgery is based on an evaluation of the individual patient's data. If MRONJ, the oncologist may consider a drug holiday until soft tissue closure. No studies support or refute the strategy of stopping Dmab in the prevention or treatment of MRONJ. |
| Diagnosis and Management of Osteonecrosis of the Jaw: A systematic review and International Consensus [11] | Canada | 2014 | Drug holiday after oral surgery and until complete soft tissue healing has occurred. |
| Medication Related Osteonecrosis of the Jaw: 2015 Position Statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons [14] | Korea | 2015 | No definite conclusion is made regarding drug holiday. Only if MRONJ is present, the necessity of a drug holiday is clear. |
| "Positionspapier zur medikamentenassoziierten Osteonekrose des Kiefers (MRONJ)" [12] | Germany | 2016 | A 2 months drug holiday before oral surgery is recommended. If Dmab, the discontinuation can be shorter. Resumption when complete healing has occurred. |
| Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw [15] | Japan | 2016 | No consensus regarding drug holiday before invasive dental treatment. The decision on whether to implement a postoperative drug holiday should be made jointly by the physician and dentist based on fracture risk. Resumption of BP from 2 weeks to 2 months postoperatively. |
| Standard Operation Procedure, Medication-related Osteonecrosis of the Jaws (Not published) | Denmark | 2016 | The oncologist discontinues the ARs before referral to the oral surgeons. |
| Case-Based Review of Osteonecrosis of the Jaw (ONJ) and Application of the International Recommendations for Management From the International Task Force on ONJ [13] | Canada | 2017 | Interruption of BP or Dmab therapy is advised, if possible before oral surgery and until soft tissue healing has occurred. The treatment plan must be individualized for each patient. |
| Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw [18] | Scotland | 2017 | Drug holidays to avoid the risk of MRONJ associated with dental care are not recommended. |
AR: Antiresorptive; BP: Bisphosphonate; MRONJ: Medication-related osteonecrosis of the jaw; Dmab: Denosumab.