Medication-Related Osteonecrosis of the Jaw

Osteonecrosis of the jaw (ONJ) is a common side effect of antiresorptive drugs that are administered to cancer patients for bone metastasis, multiple myeloma, and osteoporosis. Since both bisphosphonate (BP) and denosumab show anti-bone resorption effects with ONJ, antiresorptive agent-related ONJ (ARONJ) has been suggested as a comprehensive term encompassing both BP-related osteonecrosis of the jaw (BRONJ) and denosumab-related osteonecrosis of the jaw (DRONJ). The term medication-related osteonecrosis of the jaw (MRONJ) is proposed as ARONJ with the antiangiogenic inhibitors or molecularly targeted drugs-related ONJ. Suppression of bone remodeling may contribute to the development of osteonecrosis and results in inadequate osteoclast activity to allow healing of the extraction socket. Infection is a major factor in the development of MRONJ. The major treatment goals for patients at risk of developing or who have MRONJ are prioritization and support of continued oncologic treatment in patients receiving antiresorptive and antiangiogenic therapy. To minimize the development of MRONJ in patients at risk, regular dental examinations are encouraged. Oral hygiene should be improved and local infection is managed as early as possible. The use of antibiotics before and after oral surgical procedures has been demonstrated to lower the risk of MRONJ.