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. 2024 Sep 25;12(10):2179.
doi: 10.3390/biomedicines12102179.

A Multi-Center Observation Study on Medication-Related Osteonecrosis of the Jaw (MRONJ) in Patients with Osteoporosis, and Other Non-Malignant Bone Diseases, in Northwestern Italy over 16 Years

Dora Karimi  1 , Paolo Giacomo Arduino  1 , Alessio Gambino  1 , Francesco Erovigni  1 , Alessandro Dell'Acqua  1 , Francesco Pera  1 , Massimo Carossa  1 , Monica Pentenero  2 , Paolo Appendino  3 , Francesco Della Ferrera  3 , Antonella Fasciolo  4 , Majlinda Caka  5 , Mario Migliario  6 , Matteo Brucoli  7 , Stefano Franchi  7 , Alessandro Pezzimenti  8 , Vittorio Fusco  9
Affiliations

A Multi-Center Observation Study on Medication-Related Osteonecrosis of the Jaw (MRONJ) in Patients with Osteoporosis, and Other Non-Malignant Bone Diseases, in Northwestern Italy over 16 Years

Dora Karimi et al. Biomedicines. .

Abstract

Objectives: To assess the number of new cases of Medication-Related Osteonecrosis of the Jaw (MRONJ) among patients with osteoporosis and other non-malignant bone diseases in Northwestern Italy between 2007 and 2022.

Methods: MRONJ cases were collected from referral centers in a population of 4.5 million. We analysed the number of new MRONJ cases per year, type of disease, administered drugs, duration of therapy (when available), and onset time of disease.

Results: We analysed 198 cases (out of 1071 total MRONJ cases); diseases included osteoporosis (87%), rheumatoid arthritis (5%), their association (4%), Paget's disease, and other various diseases (4%). Patients received bisphosphonates alone (74%), or denosumab alone (6%), or a sequence of different drugs (20%). The number of new cases increased over five years from 2 (2003-2007) to 51 (2008-2012), 65 (2013-2017), and 79 (2018-2022), and the percentage increased from 1% to 14%, 20%, and 29% of the total cases.

Conclusions: The number of new MRONJ cases per year among patients with non-malignant diseases is rapidly increasing all around the world, though underestimation cannot be excluded. In this study, we describe epidemiological and clinical characteristics of patients, and the drug most frequently involved in MRONJ cases in our region over a long period, allowing a comprehensive view of the progression of the disease. Greater collaboration among specialists is needed for correct and early diagnosis to improve measures potentially reducing disease incidence and to limit quality of life deterioration in patients with osteoporosis and other non-malignant diseases.

Keywords: alendronate; bisphosphonates; denosumab; incidence; osteonecrosis of the jaw; osteoporosis.

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Conflict of interest statement

The authors declare no conflicts of interest; the funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Number of MRONJ cases per year of diagnosis (global and per drug or sequence). ALE = alendronate; BP = bisphosphonate; DEN = denosumab; IBA = ibandronate; ZOL = zoledronic acid; NK = not known.
See this image and copyright information in PMC

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