Medication-related osteonecrosis of the jaw: a narrative review of risk factors, diagnosis, and management

Abstract

Background and Objective: This article provides a detailed and up-to-date narrative review of the risk factors, diagnosis, and management of medication-related osteonecrosis of the jaw (MRONJ). MRONJ is an emerging topic of research, and there is a growing list of new drugs associated with MRONJ, diagnostic strategies, and treatment techniques that may aid in management. Methods: A comprehensive review of the literature in English was conducted, using databases such as PubMed, OVID, UpToDate, and Lexicomp to find relevant articles and information and prioritizing articles from 2014 to 2021. Key Content and Findings: MRONJ is an uncommon disease in patients exposed to antiresorptive and/ or antiangiogenic agents, such as those with osteoporosis and/or cancer. Dentoalveolar surgery is the most common initiating factor for MRONJ, and there are many patient-related and medication-related factors that increase risk for occurrence. Diagnosis is primarily based on clinical factors, and MRONJ presentation may range from an asymptomatic, localized lesion with no sequelae to infected bone leading to pathologic fracture requiring major oral surgery. Prevention plays a key role in management and should take place before initiation of drug therapy, as well as during and after drug therapy. For treatment, conservative measures typically provide symptomatic relief, while surgical resection has been shown to be more curative. Conclusions: MRONJ may lead to significant morbidity in affected patients, and providers must use the most up-to-date information to characterize patient risk, detect disease early, and treat appropriately based on severity.