Vitamin D Deficiency Investigation in Oncologic Patient Undergoing Surgical Management of Medication Related Osteonecrosis of the Jaw: A Clinical Prospective Study

Medication-related osteonecrosis of the jaw (MRONJ) is defined as an area of exposed bone, or bone that can be probed through an intraoral or extraoral fistula persisted for greater than 8 weeks in patient with current or previous treatment with bisphosphonates, denosumab, or antiangiogenic therapy without history of radiation therapy to the jaw or obvious metastatic disease of the jaw. The physiopathology remains a controversial subject including the possible involvement of vitamin D deficiency. Purpose: discuss the involvement of vitamin D deficiency in MRONJ development. This through a series of five clinical cases and a review of the literature. Observations: A series of 5 clinical cases of MRONJ associated with vitamin D deficiency whose management was medico-surgical were included. The series included 2 women and 3 men of average age 54,8 years who were treated for malignant diseases and whose average serum vitamin D level was 10 ng / ml. Remission was complete in 4 cases and partial in 1 case. Discussion: Several epidemiological studies have shown a high prevalence of hypovitaminosis D in different apparently healthy populations. Moreover, Vitamin D deficiency has recently been incriminated as an added risk factor for MRONJ. It has been postulated through experimental and control case studies that systemic conditions associated with cancer patients with a vitamin D deficiency combined with tooth extraction may increase the risk of MRONJ. Conclusion: MRONJ is a known complication of Bisphosphonate. Additional processes would be involved in the genesis of MRONJ including the possible role of a vitamin D deficiency but the scientific evidence of their involvement is not yet fully characterized.