Comparative Inpatient Burden of Osteoradionecrosis in Head and Neck Cancer Versus Medication-Related Osteonecrosis of the Jaw in Multiple Myeloma: A U.S. National Analysis

Objective: The objective of this study was to compare the impact of osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) on costs and length of stay (LOS) for patients hospitalized for head and neck cancer (HNC) and multiple myeloma (MM). Methods: This retrospective cohort study utilized the 2017 National Inpatient Sample. We identified HNC patients with ORN and MM patients with severe MRONJ using the International Classification of the Disease-10 Clinical Modification codes. The outcomes were hospital charges and LOS. Results: Of the 47,195 patients with HNC, 980 (2.1%) were diagnosed with ORN. Of the 113,915 patients with MM, 170 (0.1%) were diagnosed with severe MRONJ requiring hospitalization. ORN was independently associated with a longer LOS (coef = 1.75, 95% CI: 1.18–2.59) and higher charges (coef = 1.49, 95% CI: 1.13–1.98). MRONJ as the principal diagnosis was associated with a longer LOS (coef = 1.92, 95% CI: 1.28–2.88) and higher charges (coef = 1.78, 95% CI: 1.22–2.60), whereas incidental (secondary) MRONJ showed no significant incremental burden. Conclusions: ORN is associated with substantial inpatient resource utilization in HNC patients. Severe MRONJ requiring hospitalization as the primary indication incurs comparable incremental costs and LOS, while incidental MRONJ identified during MM-related admissions does not significantly increase resource use.