Chinese expert consensus on the diagnosis and clinical management of medication-related osteonecrosis of the jaw

Han-Jin Ruan¹, Heng Chen¹, Jin-Song Hou², Jin-Gang An³, Yu-Xing Guo⁴, Bing Liu⁵, Lei Tian⁶, Jian Pan⁷, Jin-Song Li⁸, Can-Hua Jiang⁹, Zhen Tian¹⁰, Jie Xu¹¹, Ling Zhu¹², Chang-Fu Sun¹³, Ke-Qian Zhi¹⁴, Qing Qu¹⁵, Chun-Lin Zong¹⁶, Meng-Yu Li¹, Zhi-Yuan Zhang¹, Yue He¹⁷

Affiliations

¹ Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.
² Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
³ National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.
⁴ Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China.
⁵ The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, Department of Oral Maxillofacial Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China.
⁶ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Centre for Oral Diseases, Shaanxi Clinical Research Centre for Oral Diseases, Department of Orthognathic Trauma Surgery, The Third Affiliated Hospital of Air Force Medical University, Oral Biomechanics Basic and Clinical Research Innovation Team, Xi'an, China.
⁷ State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Oral Regenerative Medicine & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, China.
⁸ Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China.
⁹ Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
¹⁰ Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Centre for Stomatology, National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
¹¹ Department of Infectious Disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹² Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹³ Department of Oromaxillofacial-Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, China.
¹⁴ Department of Oral and Maxillofacial Reconstruction, Department of Oral and Maxillofacial Surgery, School of Stomatology, Qingdao University, Key Laboratory of Oral Clinical Medicine, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
¹⁵ Department of Oncology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁶ State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
¹⁷ Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Disease, National Clinical Research Center for Oral Diseases, Shanghai, China.

PMID: 39651419
PMCID: PMC11621599
DOI: 10.1016/j.jbo.2024.100650

Review

Chinese expert consensus on the diagnosis and clinical management of medication-related osteonecrosis of the jaw

Han-Jin Ruan et al. J Bone Oncol. 2024.

. 2024 Nov 19:49:100650.

doi: 10.1016/j.jbo.2024.100650. eCollection 2024 Dec.

Authors

Affiliations

¹ Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.
² Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
³ National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.
⁴ Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China.
⁵ The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, Department of Oral Maxillofacial Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China.
⁶ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Centre for Oral Diseases, Shaanxi Clinical Research Centre for Oral Diseases, Department of Orthognathic Trauma Surgery, The Third Affiliated Hospital of Air Force Medical University, Oral Biomechanics Basic and Clinical Research Innovation Team, Xi'an, China.
⁷ State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Oral Regenerative Medicine & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, China.
⁸ Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China.
⁹ Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
¹⁰ Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Centre for Stomatology, National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
¹¹ Department of Infectious Disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹² Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹³ Department of Oromaxillofacial-Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, China.
¹⁴ Department of Oral and Maxillofacial Reconstruction, Department of Oral and Maxillofacial Surgery, School of Stomatology, Qingdao University, Key Laboratory of Oral Clinical Medicine, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
¹⁵ Department of Oncology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁶ State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
¹⁷ Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Disease, National Clinical Research Center for Oral Diseases, Shanghai, China.

PMID: 39651419
PMCID: PMC11621599
DOI: 10.1016/j.jbo.2024.100650

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a side effect that occurs after treatment for systemic diseases. However, most institutions currently rely on empirical methods to make diagnosis and treatment plans, and there is a lack of consensus or guidelines for the classification, staging and treatment of MRONJ in China. To address this gap and improve prognosis, an expert panel representing 11 renowned domestic medical colleges and affiliated hospitals in China was convened. The panel made a comprehensive literature review of previous treatment experiences and research findings to address issues of definitions, etiology and risk factors, diagnosis, treatment and prevention methods. The panel concluded that the diagnosis of MRONJ can be made on the basis of a history of related medications and typical clinical manifestations, with either typical radiographic manifestations or histopathological manifestations, after excluding jaw metastasis. Surgical treatment should be considered for symptomatic patients with sequestrum or bone abnormalities accompanied by recurrent infections, and He's classification was considered a practical clinical MRONJ staging system. Multidisciplinary comprehensive treatment should be proposed to achieve optimal treatment outcomes.

Keywords: Bisphosphonates; Consensus; Denosumab; Jaw; Osteonecrosis; Practice guidelines.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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References

1. Lu Z., Chen Y., Liu D., Jiao X., Liu C., Wang Y., Zhang Z., Jia K., Gong J., Yang Z., Shen L. The landscape of cancer research and cancer care in China. Nat. Med. 2023;29:3022–3032. doi: 10.1038/s41591-023-02655-3. - DOI - PubMed
1. Hiensch A.E., Depenbusch J., Schmidt M.E., Monninkhof E.M., Pelaez M., Clauss D., Gunasekara N., Zimmer P., Belloso J., Trevaskis M., Rundqvist H., Wiskemann J., Müller J., Sweegers M.G., Fremd C., Altena R., Gorecki M., Bijlsma R., van Leeuwen-Snoeks L., Huinink D. ten B., Sonke G., Lahuerta A., Mann G.B., Francis P.A., Richardson G., Malter W., van der Wall E., Aaronson N.K., Senkus E., Urruticoechea A., Zopf E.M., Bloch W., Stuiver M.M., Wengstrom Y., Steindorf K., May A.M. Supervised, structured and individualized exercise in metastatic breast cancer: a randomized controlled trial. Nat. Med. 2024;30:2957. doi: 10.1038/s41591-024-03143-y. - DOI - PMC - PubMed
1. Hernandez R.K., Wade S.W., Reich A., Pirolli M., Liede A., Lyman G.H. Incidence of bone metastases in patients with solid tumors: analysis of oncology electronic medical records in the United States. BMC Cancer. 2018;18:44. doi: 10.1186/s12885-017-3922-0. - DOI - PMC - PubMed
1. Reid I.R., McClung M.R. Osteopenia: a key target for fracture prevention. Lancet Diabetes Endocrinol. 2024;12:856–864. doi: 10.1016/S2213-8587(24)00225-0. - DOI - PubMed
1. Zhu N., Ni H., Guo S., Shen Y.-Q., Chen Q. Bone complications of cancer treatment. Cancer Treat. Rev. 2024;130 doi: 10.1016/j.ctrv.2024.102828. - DOI - PubMed

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Chinese expert consensus on the diagnosis and clinical management of medication-related osteonecrosis of the jaw

Affiliations

Chinese expert consensus on the diagnosis and clinical management of medication-related osteonecrosis of the jaw

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources

Miscellaneous