Denosumab has shown to be noninferior to zoledronic acid for the prevention of skeletal-related events and provides an alternative .
Fewer adverse events related to renal toxicity have been noted with denosumab compared with zoledronic acid and may be preferred in this setting .
Purpose To up date guideline recommendations on the role of bone-modifying agents in multiple myeloma .
Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw.
PURPOSE The reported incidence of osteonecrosis of the jaw ( ONJ ) ranges from 0.94 % to 18.6 % . This cohort study aim ed to calculate the incidence of and identify the risk factors for ONJ  in patients with cancer treated with intravenous zoledronate , ib and ronate , and pamidronate .  PATIENTS AND METHODS Data analyzed included age , sex , smoking status , underlying disease , medical and dental history , bisphosphonates ( BP ) type , and doses administered . Relative risks , crude and adjusted odds ratios ( aORs ) , and cumulative hazard ratios for ONJ development were calculated . RESULTS We included 1,621 patients who received 29,006 intravenous doses of BP , given monthly .  Crude ONJ incidence was 8.5 % , 3.1 % , and 4.9 % in patients with multiple myeloma , breast cancer , and prostate cancer , respectively . Patients with breast cancer demonstrated a reduced risk for ONJ development , which turned out to be nonsignificant after adjustment for other variables . Multivariate analysis demonstrated that use of dentures ( aOR = 2.02 ; 95 % CI , 1.03 to 3.96 ) , history of dental extraction ( aOR = 32.97 ; 95 % CI , 18.02 to 60.31 ) , having ever received zoledronate ( aOR = 28.09 ; 95 % CI , 5.74 to 137.43 ) , and each zoledronate dose ( aOR = 2.02 ; 95 % CI , 1.15 to 3.56 ) were associated with increased risk for ONJ development . Smoking , periodontitis , and root canal treatment did not increase risk for ONJ in patients receiving BP .  CONCLUSION The conclusions of this study vali date d dental extraction s and use of dentures as risk factors for ONJ development . Ib and ronate and pamidronate at the dosages and frequency used in this study seem to exhibit a safer drug profile concerning ONJ complication ; however , r and omized controlled trials are needed to vali date these results . Before initiation of a bisphosphonate , patients should have a comprehensive dental examination . Patients with a challenging dental situation should have dental care attended to before initiation of these drugs
Denosumab has shown to be noninferior to zoledronic acid for the prevention of skeletal-related events and provides an alternative .
Fewer adverse events related to renal toxicity have been noted with denosumab compared with zoledronic acid and may be preferred in this setting .
Purpose To up date guideline recommendations on the role of bone-modifying agents in multiple myeloma .