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. 2024 May 13;16(5):e60223.
doi: 10.7759/cureus.60223. eCollection 2024 May.

Pathogenesis of Medication-Related Osteonecrosis of the Jaw: Odontogenic Infection-Preceding Type and Osteonecrosis-Preceding Type

Yuki Sakamoto  1 , Shunsuke Sawada  2 , Yuka Kojima  3   4
Affiliations

Pathogenesis of Medication-Related Osteonecrosis of the Jaw: Odontogenic Infection-Preceding Type and Osteonecrosis-Preceding Type

Yuki Sakamoto et al. Cureus. .

Abstract

Introduction Medication-related osteonecrosis of the jaw (MRONJ) develops from odontogenic infection. However, there are also some cases of MRONJ developing from sites with no teeth, no root canal lesions, or no periodontal disease. This study aimed to retrospectively review radiographic images of MRONJ cases and examine the differences in characteristics between MRONJ suspected to be related to dental infection (odontogenic MRONJ) and MRONJ that occurred without dental involvement or of unknown cause (non-odontogenic MRONJ). Materials and methods One hundred and forty-five patients were diagnosed with MRONJ at Kansai Medical University Hospital and Kansai Medical University Medical Center. The following variables were investigated: sex, age, primary disease, MRONJ site, body mass index, smoking habit, diabetes, corticosteroids, type of antiresorptive agent, administration period, CT findings (separation of sequestrum, osteolysis, periosteal reaction, and osteosclerosis), trigger, leukocytes, neutrocytes, neutrophil-lymphocyte ratio, serum albumin, and serum creatinine levels. Results In the univariate analysis, significant differences between odontogenic and non-odontogenic MRONJs were found in patients whose primary disease was malignancy, receiving denosumab (DMB), and with short administration period of antiresorptive agent, no osteolysis, periosteal reaction, and serum creatinine level. In multivariate analysis, non-odontogenic MRONJ was significantly more common in patients with no osteolysis and with periosteal reaction. Conclusion Non-odontogenic MRONJ tends to occur more frequently in patients treated with high-dose DMB, and there were significantly more cases of non-osteolytic MRONJ without radiographic evidence of osteolysis or with periosteal reactions.

Keywords: infection; mronj; non-odontogenic; odontogenic; preceding osteonecrosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Possible causes of MRONJ development
A, B: Severe periodontal disease is observed in the bicuspids and molars, and the development of MRONJ from dental infection is suspected. C, D: MRONJ, possibly caused by an infection from a denture ulcer. E, F: Extensive MRONJ in the body of the bone, remote from the teeth, with no bone exposure to the oral cavity and a cutaneous fistula MRONJ: medication-related osteonecrosis of the jaw
Figure 2
Figure 2. Hypothesis of MRONJ pathogenesis: preceding osteonecrosis, non-odontogenic type
Image Credit: Yuki Sakamoto MRONJ: medication-related osteonecrosis of the jaw
Figure 3
Figure 3. Hypothesis of MRONJ pathogenesis: preceding osteonecrosis, odontogenic type
Image Credit: Yuki Sakamoto MRONJ: medication-related osteonecrosis of the jaw
Figure 4
Figure 4. Hypothesis of MRONJ pathogenesis: preceding infection type
Image Credit: Yuki Sakamoto MRONJ: medication-related osteonecrosis of the jaw
See this image and copyright information in PMC

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