Association between Hyperglycemia and Medication-Related Osteonecrosis of the Jaw (MRONJ)

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a type of jawbone necrosis caused by the use of drugs for some types of cancer and osteoporosis. The current study aimed to evaluate the associations between hyperglycemia and the development of medication-related osteonecrosis of the jaw. Methods: Our research group investigated data collected between 1 January 2019 and 31 December 2020. A total of 260 patients were selected from the Inpatient Care Unit, Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University. Fasting glucose data were used and included in the study. Results: Approximately 40% of the necrosis group and 21% of the control group presented with hyperglycemia. There was a significant association between hyperglycemia and MRONJ (p < 0.05, p = 0.003). Vascular anomaly and immune dysfunction caused by hyperglycemia can lead to necrosis after tooth extraction. Necrosis is more common in the mandible (75.0%) and in the case of parenteral antiresorptive treatment (intravenous Zoledronate and subcutaneous Denosumab). Hyperglycemia is a more relevant risk factor than bad oral habits (26.7%). Conclusions: Ischemia is a complication of abnormal glucose levels, a possible risk factor for necrosis development. Hence, uncontrolled or poorly regulated plasma glucose levels can significantly increase the risk of jawbone necrosis after invasive dental or oral surgical interventions.

Are medication-induced salivary changes the culprit of osteonecrosis of the jaw? A systematic review

“…This study analyzed baseline characteristics such as age, gender, cancer type, presence of osteoporosis, and habits, in addition to the possible synergistic impact of hyperglycemia and AR therapy that may result in hyposalivation and ischemia. Ischemia is a potential risk factor for mandibular necrosis following invasive dental or oral surgical procedures ( 44 ). Additionally, several factors have been identified to play a role in the pathogenesis of MRONJ in diabetic patients, including compromised bone microenvironment, altered immune cell function, increased infection and inflammation, inhibition of osteoclast function, and induction of apoptosis, microvascular damage, and genetic predisposition ( 45 ).…”

Antiresorptive Versus Anabolic Therapy in Managing Osteoporosis in People with Type 1 and Type 2 Diabetes

“…Microvascular ischemia, endothelial cell dysfunction, reduced bone remodeling, and increased apoptosis of bone cells related to T1D and T2D could contribute to the development of MRONJ. [44] While MRONJ has been associated with hyperglycemia, [45,46] studies have produced conflicting results regarding the prevalence of T1D and T2D among individuals with MRONJ. Some observational studies have not reported a higher prevalence of T2D, [45,46] while others have shown an increased prevalence.…”

“…[44] While MRONJ has been associated with hyperglycemia, [45,46] studies have produced conflicting results regarding the prevalence of T1D and T2D among individuals with MRONJ. Some observational studies have not reported a higher prevalence of T2D, [45,46] while others have shown an increased prevalence. [44,47] Therefore, further research is warranted to elucidate the underlying mechanisms and clarify the association between hyperglycemia and the development of MRONJ in individuals with T1D and T2D.…”