Medication-related osteonecrosis of the jaw: An update

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 et al. 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.

Keywords: Antiresorptive; bisphosphonate; denosumab; osteonecrosis.