Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review

Abstract

Background Medication-related osteonecrosis of the jaw (MRONJ), which was first reported as bisphosphonate-related osteonecrosis of the jaw (BRONJ) in bisphosphonate users, is a rare but severe soft and hard tissue disease induced by several types of medications. There has been a deluge of information about MRONJ, such as epidemiology, risk factors, clinical recommendations for dental treatment to prevent it, and treatment strategies in medication-prescribed users. The aim of this study was to comprehensively review recent articles and provide the current scientific information about MRONJ, especially clinical considerations or recommendations for dental treatment to prevent its occurrence. Materials and methods The current literature review was mainly based on 14 systematic reviews with or without meta-analysis, 4 position papers, 1 consensus statement, 1 clinical guideline, and 2 clinical reviews regarding MRONJ after a PubMed database and manual searches according to inclusion and exclusion criteria. Moreover, 53 articles were selected by manual search in regard to all references from selected articles and other articles identified on the PubMed search, irrespective of publication date, and inclusion and exclusion criteria. Results The incidence and prevalence of MRONJ are relatively low, although they are clearly higher in cancer patients receiving high-dose antiresorptive agents or angiogenesis inhibitors rather than osteoporosis patients receiving oral bisphosphonates or denosumab. There are many types of local, systemic, and other risk factors for the development of MRONJ. Clinical recommendations are provided for each clinical situation of patients to prevent MRONJ. There are also treatment strategies for MRONJ in each stage. Conclusions General dentists should perform appropriate dental treatment to prevent MRONJ in the patients prior to or when receiving medications that could induce MRONJ. Moreover, there are treatment strategies for MRONJ in each stage that oral surgeons could follow. Adequate and updated clinical information regarding MRONJ based on scientific data is required whenever possible.

Analysis of Factors Associated with the Postoperative Healing of Medication-Related Osteonecrosis of the Jaw in Patients with Osteoporosis

“…The current literature suggests various treatment strategies for MRONJ depending on its stage and other clinical parameters of the patient [3,6,11,22]. Despite non-surgical treatment options, the surgical approach is still considered the best treatment choice of MRONJ [10,12,13,[23][24][25].…”

“…While these drugs are used to treat bone metastases and osteoporosis, these have been affecting the quality of life related to oral health, Refs. [1,[4][5][6] making daily dental treatment more challenging.…”

Review of Myeloma Therapies and Their Potential for Oral and Maxillofacial Side Effects

“…Another study of patients with advanced cancer treated with either zoledronic acid or denosumab, found 13/155 (8.4%) developed MRONJ, which was significantly associated with the number of infusions and the duration of antiresorptive therapy [12]. A recent literature review and meta-analysis including 13,857 patients reported the prevalence of MRONJ after receiving zoledronic acid for cancer ranged from 0.4-1.6% after one year, 0.8-2.1% after two years, and 1.3-2.3% after three years, with greater incidence after more years of administration [13]. ONJ incidence secondary to denosumab therapy ranged from 0.5% to 2.1% after one year, 1.1-3.0% after two years, and 1.3-3.2% after three years of treatment [13].…”

“…A recent literature review and meta-analysis including 13,857 patients reported the prevalence of MRONJ after receiving zoledronic acid for cancer ranged from 0.4-1.6% after one year, 0.8-2.1% after two years, and 1.3-2.3% after three years, with greater incidence after more years of administration [13]. ONJ incidence secondary to denosumab therapy ranged from 0.5% to 2.1% after one year, 1.1-3.0% after two years, and 1.3-3.2% after three years of treatment [13].…”

“…Comorbid diseases including non-insulin dependent diabetes, cardiovascular and respiratory disease, kidney disorders, haematological disorders, tobacco consumption, and mental health illness are reported to significantly increase the odds of developing MRONJ [46]. MRONJ is reported more commonly in older patients, independent of other risk factors [13]. MRONJ is also more common in women than men; however, this is thought to be related to the increased use of BMA in women with osteoporosis and metastatic breast cancer [1].…”