Medication-related osteonecrosis of the jaw – a scoping review

Abstract

Medication-related osteonecrosis of the jaw [MRONJ] is a rare, often intractable, and debilitating condition that is associated with multiple therapies. The condition can be asymptomatic or become chronic adversely affecting the patient's quality of life. Case definitions of MRONJ have been given by the American Association of Oral and Maxillofacial Surgeons [AAOMS] and the American Society for Bone and Mineral Research [ASBMR] and history of use [or current] of anti-resorptive agents and anti-angiogenic agents form a key component of the definition. The exact pathophysiology of this condition remains unclear though the jaw and especially the mandible is uniquely susceptible. Beyond drug treatment, there are several risk factors that have been identified for MRONJ that include among others local, demographic, systemic and genetic factors. Management of the condition is multi-disciplinary and includes both surgical and conservative approaches depending upon the stage of the disease. Several experimental treatments have been tried some of which include photo biomodulation, hyperbaric oxygen therapy and use of autologous platelet concentrates. Mitigation of MRONJ begins with risk assessment and counselling of the patients prior to initiating treatments known to be associated with it and regular ongoing monitoring. As more and more biologics enter the market, MRONJ has come to be associated not just with bisphosphonates or denosumab but also with drugs like tyrosine kinase inhibitors and calcineurin inhibitors and physicians need to bear this in mind.