What Researchers Did
Researchers reviewed clinical trials testing treatments for a rare jaw bone problem, called BRONJ, that can occur in people taking bone-strengthening drugs called bisphosphonates.
What They Found
This Cochrane systematic review identified only one small randomized trial, at high risk of bias, that met its inclusion criteria. The trial randomized 49 participants, most of whom had cancer, comparing standard care (surgery, antibiotics, and oral rinses) to standard care plus hyperbaric oxygen therapy (2 ATA, twice daily, for 40 treatments). At three months, participants who received hyperbaric oxygen were more likely to show improvement in their jaw osteonecrosis than those on standard care alone (risk ratio 1.94, 95% confidence interval 1.01 to 3.74), though there was no clear difference between groups in full healing at three months (risk ratio 3.60, 95% CI 0.87 to 14.82), and no clear difference in improvement or healing at six, 12, or 18 months or at last contact. The trial reported no information on adverse events.
What This Means for Canadian Patients
For patients with bisphosphonate-related jaw osteonecrosis, this single small trial suggests adding hyperbaric oxygen to standard care may improve short-term outcomes at three months, but the same trial found no clear difference at later timepoints, and the review authors state this could not confirm or refute whether hyperbaric oxygen is effective. No randomized trials of any other BRONJ treatment were found.
Canadian Relevance
No direct Canadian connection identified.
Study Limitations
The review's findings rest on a single underpowered trial at high risk of bias, with no blinding, cross-over of participants between groups, and very high attrition (50% at 12 months and 80% at 18 months, against an intended 24-month follow-up), which the authors say leaves the overall quality of evidence very low.