Medication-related Osteonecrosis of the Jaw: An Update

Overview

Journal Natl J Maxillofac Surg

Date 2022 Aug 1

PMID 35911799

Authors

Hitesh Bansal

Affiliations

Soon will be listed here.

Abstract

Antiresorptive medications, such as bisphosphonates and denosumab, are an important class of medication used to treat a wide range of diseases from osteoporosis to multiple myeloma. Unfortunately, they are also associated with a rare but devastating side effect - medication-related osteonecrosis of the jaw (MRONJ). First reported in 2003, much research has been done into the area; however, the exact pathophysiology continues to elude clinicians and researchers. What has been ascertained is that intravenous treatment, duration of treatment, and tooth extraction are major risk factors. Staging and treatment guidelines have been proposed; however, there has been no universal acceptance, and clinicians rely on various position papers. Over the next 30 years, the aging population is set to double, and with it, the prescription of antiresorptive medication and incidence of MRONJ will undoubtedly increase. In 2013, Gupta . published a paper on bisphosphonate-related osteonecrosis of the jaw; however, there have many changes since then. This paper aims to provide a succinct update on those changes.

Citing Articles

Knowledge and Awareness of Medication-Related Osteonecrosis of the Jaw Among Dental Practitioners in Mumbai: A Questionnaire-Based Survey.

Shapurwala M, Kharkar V, More S, Kalsi H, Sachdev S Cureus. 2025; 16(12):e76448.

PMID: 39867037 PMC: 11769707. DOI: 10.7759/cureus.76448.

Frutuoso F, Freitas F, Vilares M, Francisco H, Marques D, Carames J Diseases. 2024; 12(9).

PMID: 39329874 PMC: 11431443. DOI: 10.3390/diseases12090205.

Could MRONJ Be Related to Osimertinib Monotherapy in Lung Cancer Patients after Denosumab Suspension?.

Forte M, dAmati A, Limongelli L, Corsalini M, Favia G, Ingravallo G Healthcare (Basel). 2024; 12(4).

PMID: 38391832 PMC: 10888159. DOI: 10.3390/healthcare12040457.

A Narrative Review of Osteonecrosis of the Jaw: What a Clinician Should Know.

Sharma S, Shankar R, Ravi Kiran B, Breh R, Sarangi S, Upadhyay A Cureus. 2024; 15(12):e51183.

PMID: 38283469 PMC: 10817767. DOI: 10.7759/cureus.51183.

Relationship between Medication-Related Osteonecrosis of the Jaw and CDK4/6 Inhibitors in Breast Cancer.

Dominguez Senin L, Morales Pancorbo D, Garces M, Santos-Rubio M, Bayo Calero J Curr Oncol. 2024; 31(1):250-259.

PMID: 38248101 PMC: 10814865. DOI: 10.3390/curroncol31010016.

References

Reid I, Bolland M, Grey A . Is bisphosphonate-associated osteonecrosis of the jaw caused by soft tissue toxicity?. Bone. 2007; 41(3):318-20. DOI: 10.1016/j.bone.2007.04.196. View

Yamazaki T, Yamori M, Ishizaki T, Asai K, Goto K, Takahashi K . Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study. Int J Oral Maxillofac Surg. 2012; 41(11):1397-403. DOI: 10.1016/j.ijom.2012.06.020. View

Khan A, Morrison A, Hanley D, Felsenberg D, McCauley L, ORyan F . Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2014; 30(1):3-23. DOI: 10.1002/jbmr.2405. View

Tsao C, Darby I, Ebeling P, Walsh K, OBrien-Simpson N, Reynolds E . Oral health risk factors for bisphosphonate-associated jaw osteonecrosis. J Oral Maxillofac Surg. 2013; 71(8):1360-6. DOI: 10.1016/j.joms.2013.02.016. View

Hinchy N, Jayaprakash V, Rossitto R, Anders P, Korff K, Canallatos P . Osteonecrosis of the jaw - prevention and treatment strategies for oral health professionals. Oral Oncol. 2013; 49(9):878-886. DOI: 10.1016/j.oraloncology.2013.06.008. View

Boonyapakorn T, Schirmer I, Reichart P, Sturm I, Massenkeil G . Bisphosphonate-induced osteonecrosis of the jaws: prospective study of 80 patients with multiple myeloma and other malignancies. Oral Oncol. 2008; 44(9):857-69. DOI: 10.1016/j.oraloncology.2007.11.012. View

Sedghizadeh P, Kumar S, Gorur A, Schaudinn C, Shuler C, Costerton J . Identification of microbial biofilms in osteonecrosis of the jaws secondary to bisphosphonate therapy. J Oral Maxillofac Surg. 2008; 66(4):767-75. DOI: 10.1016/j.joms.2007.11.035. View

Sankar P, Thilak S, Nayak P, Tripathy J, Satheesan B, Rajitha A . Osteonecrosis of the Jaw among Patients Receiving Antiresorptive Medication: A 4-year Retrospective Study at a Tertiary Cancer Center, Kerala, India. Contemp Clin Dent. 2018; 9(1):35-40. PMC: 5863406. DOI: 10.4103/ccd.ccd_696_17. View

Baron R, Ferrari S, Russell R . Denosumab and bisphosphonates: different mechanisms of action and effects. Bone. 2010; 48(4):677-92. DOI: 10.1016/j.bone.2010.11.020. View

10.

Guarneri V, Miles D, Robert N, Dieras V, Glaspy J, Smith I . Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer. Breast Cancer Res Treat. 2010; 122(1):181-8. DOI: 10.1007/s10549-010-0866-3. View

11.

Ruggiero S, Dodson T, Fantasia J, Goodday R, Aghaloo T, Mehrotra B . American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg. 2014; 72(10):1938-56. DOI: 10.1016/j.joms.2014.04.031. View

12.

Ruggiero S, Mehrotra B, Rosenberg T, Engroff S . Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004; 62(5):527-34. DOI: 10.1016/j.joms.2004.02.004. View

13.

Khan A, Rios L, Sandor G, Khan N, Peters E, Rahman M . Bisphosphonate-associated osteonecrosis of the jaw in Ontario: a survey of oral and maxillofacial surgeons. J Rheumatol. 2011; 38(7):1396-402. DOI: 10.3899/jrheum.100221. View

14.

de Souza Tolentino E, de Castro T, Michellon F, Passoni A, Ortega L, Iwaki L . Adjuvant therapies in the management of medication-related osteonecrosis of the jaws: Systematic review. Head Neck. 2019; 41(12):4209-4228. DOI: 10.1002/hed.25944. View

15.

Drake M, Clarke B, Khosla S . Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. 2008; 83(9):1032-45. PMC: 2667901. DOI: 10.4065/83.9.1032. View

16.

Van den Wyngaert T, Claeys T, Huizing M, Vermorken J, Fossion E . Initial experience with conservative treatment in cancer patients with osteonecrosis of the jaw (ONJ) and predictors of outcome. Ann Oncol. 2008; 20(2):331-6. DOI: 10.1093/annonc/mdn630. View

17.

Migliorati C . Bisphosphanates and oral cavity avascular bone necrosis. J Clin Oncol. 2003; 21(22):4253-4. DOI: 10.1200/JCO.2003.99.132. View

18.

Ruggiero S . Bisphosphonate-related osteonecrosis of the jaw (BRONJ): initial discovery and subsequent development. J Oral Maxillofac Surg. 2009; 67(5 Suppl):13-8. DOI: 10.1016/j.joms.2008.10.005. View

19.

Vahtsevanos K, Kyrgidis A, Verrou E, Katodritou E, Triaridis S, Andreadis C . Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. J Clin Oncol. 2009; 27(32):5356-62. DOI: 10.1200/JCO.2009.21.9584. View

20.

Pozzi S, Raje N . The role of bisphosphonates in multiple myeloma: mechanisms, side effects, and the future. Oncologist. 2011; 16(5):651-62. PMC: 3228190. DOI: 10.1634/theoncologist.2010-0225. View