Comment on Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline Summary

Case reports of medication-related osteonecrosis of the jaw (MRONJ) treated with uncultured stromal vascular fraction and L-PRF

“…Different recommendations have been made depending on the MRONJ stage [1]. Among those, the surgical procedure seems to offer better results for all the stages taken together [3]. Its goal is to reduce the procedure aggressiveness and to improve the long-term control of the disease [3].…”

One changing and challenging scenario: the treatment of cancer patients with bone metastases by bisphosphonates and denosumab, the cost–benefit evaluation of different options, and the risk of medication-related osteonecrosis of the jaw (MRONJ)

“…Real-world medical treatment of bone metastases radically changed in the last decade for the following reasons: introduction of denosumab : 120 mg monthly subcutaneous injection, with several patients already receiving zoledronic acid (or other bisphosphonates), shifted to denosumab, and many others started on denosumab from the beginning [ 1 , 4 , 7 ]; introduction of zoledronic acid every 3 months : (upfront or after a period of monthly treatment) as a possible competitor [ 9 ]; fear of the rebound effect described following denosumab discontinuation and its management [ 10 ]; difference among competing drugs and schedules in term of costs, ease of administration, staff engagement, etc . [ 8 , 9 ], with the COVID-19 pandemic likely to interfere with the routine preferences; increased awareness that skeletal-related events (SREs) — the most used study endpoint in earlier antiresorptive drug trials — are not fully reliable , and the introduction of new endpoints, so called symptomatic skeletal events (SSEs) [ 11 ]; increase of expected survival for a large proportion of bone metastatic cancer patients due to the recent advances of medical treatment (endocrine therapy, chemotherapy, targeted treatments, immunotherapy); influence of MRONJ risk evaluation , given the possible MRONJ-related worsening of patient quality of life, on antiresorptive treatment planning and management , despite several controversies still exist about MRONJ definition, diagnosis, and therapy [ 12 – 14 ]. …”

“…influence of MRONJ risk evaluation , given the possible MRONJ-related worsening of patient quality of life, on antiresorptive treatment planning and management , despite several controversies still exist about MRONJ definition, diagnosis, and therapy [ 12 – 14 ].…”

Dental Prostheses and Risk of Medication-related Osteonecrosis of the Jaw

“…As it is a complex disease, the approach to and management of MRONJ requires the involvement of primary care physicians, oncologists, oral and maxillofacial surgeons, and dentists [14].…”