. 2020 Aug 18;17(16):5998.

doi: 10.3390/ijerph17165998.

Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020

Giuseppina Campisi^{1

2}, Rodolfo Mauceri^{1

2

3}, Francesco Bertoldo^{2

4}, Giordana Bettini^{2

5}, Matteo Biasotto⁶, Giuseppe Colella⁷, Ugo Consolo⁸, Olga Di Fede^{1

2}, Gianfranco Favia⁹, Vittorio Fusco^{2

10}, Mario Gabriele¹¹, Antonio Lo Casto^{1

2}, Lorenzo Lo Muzio¹², Antonia Marcianò³, Marco Mascitti¹³, Marco Meleti¹⁴, Michele D Mignogna¹⁵, Giacomo Oteri³, Vera Panzarella^{1

2}, Umberto Romeo¹⁶, Andrea Santarelli¹³, Paolo Vescovi^{2

14}, Claudio Marchetti^{2

17}, Alberto Bedogni^{2

5}

Affiliations

¹ Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy.
² IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy.
³ Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy.
⁴ Department of Medicine, University of Verona, 37134 Verona, Italy.
⁵ Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padova, 35128 Padova, Italy.
⁶ Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy.
⁷ Department of Medical, Surgical and Dental Speciality, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
⁸ Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41125 Modena, Italy.
⁹ Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy.
¹⁰ Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy.
¹¹ Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy.
¹² Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy.
¹³ Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy.
¹⁴ Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy.
¹⁵ Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Napoli, Italy.
¹⁶ Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Roma, Italy.
¹⁷ Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy.

PMID: 32824826
PMCID: PMC7460511
DOI: 10.3390/ijerph17165998

Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020

Giuseppina Campisi et al. Int J Environ Res Public Health. 2020.

. 2020 Aug 18;17(16):5998.

doi: 10.3390/ijerph17165998.

Authors

Affiliations

¹ Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy.
² IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy.
³ Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy.
⁴ Department of Medicine, University of Verona, 37134 Verona, Italy.
⁵ Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padova, 35128 Padova, Italy.
⁶ Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy.
⁷ Department of Medical, Surgical and Dental Speciality, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
⁸ Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41125 Modena, Italy.
⁹ Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy.
¹⁰ Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy.
¹¹ Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy.
¹² Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy.
¹³ Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy.
¹⁴ Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy.
¹⁵ Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Napoli, Italy.
¹⁶ Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Roma, Italy.
¹⁷ Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy.

PMID: 32824826
PMCID: PMC7460511
DOI: 10.3390/ijerph17165998

Abstract

The Medication-Related Osteonecrosis of Jaws (MRONJ) diagnosis process and its prevention play a role of great and rising importance, not only on the Quality of Life (QoL) of patients, but also on the decision-making process by the majority of dentists and oral surgeons involved in MRONJ prevention (primary and secondary). The present paper reports the update of the conclusions from the Consensus Conference-held at the Symposium of the Italian Society of Oral Pathology and Medicine (SIPMO) (20 October 2018, Ancona, Italy)-after the newest recommendations (2020) on MRONJ were published by two scientific societies (Italian Societies of Maxillofacial Surgery and Oral Pathology and Medicine, SICMF and SIPMO), written on the inputs of the experts of the Italian Allied Committee on ONJ (IAC-ONJ). The conference focused on the topic of MRONJ, and in particular on the common practices at risk of inappropriateness in MRONJ diagnosis and therapy, as well as on MRONJ prevention and the dental management of patients at risk of MRONJ. It is a matter of cancer and osteometabolic patients that are at risk since being exposed to several drugs with antiresorptive (i.e., bisphosphonates and denosumab) or, more recently, antiangiogenic activities. At the same time, the Conference traced for dentists and oral surgeons some easy applicable indications and procedures to reduce MRONJ onset risk and to diagnose it early. Continuous updating on these issues, so important for the patient community, is recommended.

Keywords: MRONJ; antiangiogenic agents; antiresorptive drugs; bisphosphonates; cancer; denosumab; dentistry; oral surgery; osteoporosis; prevention models.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
MRONJ risk profile of patients with metabolic bone fragility receiving AR medications [19]. * It includes also CTIBL patients (hormone deprivation therapy induced bone loss in breast and prostate cancer patients without bone metastases).

**Figure 2**
Questionnaire for ONJ-related drug prescribers.

See this image and copyright information in PMC

References

1. Campisi G., Bedogni A., Bertoldo F., Bettini G., Biasotto M., Colella G., Consolo U., di Fede O., Favia G., Fusco V., et al. Proceedings of the Closed Round Table and Italian Consensus on the Medication-Related Osteonecrosis of Jaws (MRONJ) at the Symposium of Italian Society of Oral Pathology and Medicine (SIPMO) Ancona, 20 October 2018—Part I. Front. Physiol. 2019;10 doi: 10.3389/conf.fphys.2019.27.00067. - DOI
1. Campisi G., Bedogni A., Bertoldo F., Bettini G., Biasotto M., Colella G., Consolo U., di Fede O., Favia G., Fusco V., et al. Proceedings of the Closed Round Table and Italian Consensus on the Medication-Related Osteonecrosis of Jaws (MRONJ) at the Symposium of Italian Society of Oral Pathology and Medicine (SIPMO) Ancona, 20 October 2018—Part II. Front. Physiol. 2019;10 doi: 10.3389/conf.fphys.2019.27.00046. - DOI
1. Campisi G., Bedogni A., Bertoldo F., Bettini G., Biasotto M., Colella G., Consolo U., di Fede O., Favia G., Fusco V., et al. Proceedings of the Closed Round Table and Italian Consensus on the Medication-Related Osteonecrosis of Jaws (MRONJ) at the Symposium of Italian Society of Oral Pathology and Medicine (SIPMO) Ancona, 20 October 2018—Part III. Front. Physiol. 2019;10 doi: 10.3389/conf.fphys.2019.27.00040. - DOI
1. Bedogni A., Campisi G., Fusco V. Medication Related Osteonecrosis of the Jaw (MRONJ) Qeios; London, UK: 2018. - DOI - PubMed
1. Di Fede O., Panzarella V., Mauceri R., Fusco V., Bedogni A., Lo Muzio L., Board S.O., Campisi G. The dental management of patients at risk of medication-related osteonecrosis of the jaw: New paradigm of primary prevention. Biomed. Res. Int. 2018;2018:1–10. doi: 10.1155/2018/2684924. - DOI - PMC - PubMed

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Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020

Affiliations

Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical