Medication-Related Osteonecrosis: Why the Jawbone?

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) has emerged as a complication of anti-resorptive medications. Despite its low incidence rate, this problem has gained attention in recent years due to its devastating consequences and lack of preventive strategy. The fact that MRONJ incidence has been exclusive to the jawbones, despite the systemic effect of anti-resorptive medications, could be a starting point to unravel the multifactorial pathogenesis of this condition. This review aims to negotiate the question of why the jawbone is more susceptible to MRONJ than other skeletal sites. Approaching the problem from this perspective could provide new directions for the prevention of MRONJ and expand our understanding of the unique oral microenvironment.

Breakthroughs in Oral and Maxillofacial Surgery

“…The importance of the management of these patients, often subjected to multiple therapies, has highlighted the relevance of the management of possible odontogenic infections that can trigger adverse processes such as medication-related osteonecrosis of the jaws [18]. In fact, researchers have recently demonstrated that the focus of this pathology is the inflammatory-infective state of the periodontal and alveolar bone, which is the main clue for the onset of this adverse drug reaction [18,19].…”

Evaluation of Various Therapeutic Approaches in Treating Medication-related Osteonecrosis of the Jaw: A Systematic Review

“…Hadaya et al [28] exclusively observed cases in the maxilla (n=43), and Tenore et al [29] found "14 cases in the maxilla and 12 in the mandible. A recent study by Kuehn et al [30] aimed to investigate the localizing factors that render the jawbone uniquely vulnerable to osteonecrosis with long-term antiresorptive therapy". "They noted that among patients receiving anti-resorptive medications, osteonecrosis was never reported in long bones.…”

“…Initially, it was characterized as avascular osteonecrosis triggered by Pamidronate and Zoledronate, as delineated by Marx" [1]. "Subsequently, due to the escalating occurrence of osteonecrotic lesions, the term evolved to bisphosphonaterelated osteonecrosis of the jaws (BRONJ), and the last M.R.O.N.J" [1,2,3]. "MRONJ is typified by necrosis of bone tissue and oral cavity exposure, arising from a metabolic imbalance in the mineral bone matrix induced by these medications.…”

Highlights on the Effects of Non-Coding RNAs in the Osteonecrosis of the Jaw

“…Rather, there was a robust correlation between the systemic leukocyte activity and the composition of their oral microbiota. In fact, its composition has been observed to be correlated with peripheral blood leukocytes' expression of the RANK, TNF-alpha, and aryl hydrocarbon receptor genes [17][18][19] linked to stress and immunological resilience. Immune system dysfunction theory compared human and rat ONJ necrotic bone samples to healthy patients and non-ONJ locations and revealed significant differences in the quantity and distribution of T-cells.…”