Conservative Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Retrospective Cohort Study

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of bisphosphonates and anti-resorptive drugs prescribed for treatment of severe osteoporosis, Paget’s disease, and bone malignancies. The aim of this study was to evaluate the clinical outcome of a combined pharmacological and surgical management strategy on patients affected by MRONJ. Materials and methods: Medical records of patients with MRONJ were retrospectively examined to collect clinical history data. Conservative management included an initial pharmacological phase with antibiotics and antiseptic agents, followed by surgical intervention to remove bone sequestrum. Primary outcomes were healing from MRONJ at short term (1 month after surgery) and at longer term (3 months after surgery). Secondary outcome was assessment of recurrences at longer-term follow-up. Results: Thirty-five patients were included in the study with mean follow-up of 23.86 ± 18.14 months. Seven cases showed spontaneous exfoliation of necrotic bone during pharmacological therapy, which in one case did not require any further intervention. At 1-month posttreatment, 31 out of 35 (88.5%) patients showed complete healing. The 25 patients who were followed for at least 3 months revealed a healing rate of 92% (23/25). Recurrences occurred in 7 patients out 23 who showed the long-term healing, after a mean period of 7.29 ± 3.45 months. The prognostic score (University of Connecticut Osteonecrosis Numerical Scale—UCONNS) was significantly higher (p = 0.01) in patients with poor healing as compared to complete healing, both at 1 and 3 months posttreatment. Conclusions: A MRONJ treatment approach based on a combined pharmacological and surgical treatment strategy showed a high rate of healing and few recurrences.

American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaws—2022 Update

“…Exfoliation of the exposed, necrotic bone will often result in disease resolution. 63,224,225 Therefore, for those patients with Stage 2 or 3 diseases who are poor surgical candidates, nonoperative therapies may be indicated (Fig 2).…”

Risk factors and CT findings associated with treatment outcomes in patients with medication-related osteonecrosis of the jaw: A retrospective study

“…Despite the low recovery rate, conservative treatment remains the main option for patients who refuse to undergo surgery or whose general condition is insu cient to tolerate surgery. Varoni et al reported that antibiotic agents could potentially promote sequestration and the e cacy of combination therapy, including medication and surgical treatment 23 . However conservative treatment only provides temporary remission and is less likely to be curative management, it is still indispensable for a signi cant pool of patients with MRONJ.…”

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].…”