Risk factors for medication‐related osteonecrosis of the jaws: A systematic review

Abstract

The purpose of this study was to identify the patient populations at risk of medication-related osteonecrosis of the jaw (MRONJ) and determine which medical and dental comorbidities are significant risk factors for this disease. An electronic search of Embase, MEDLINE, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform and ProQuest Dissertations and Theses Global was conducted to identify all human studies that reported risk factors for MRONJ. Only a qualitative analysis was performed due to significant heterogeneity in the collected data. The search strategy identified 2872 records, of which 219 studies were eligible for inclusion. A total of 4106 patients with MRONJ were identified, 39 different systemic diseases were implicated, and 14 medical and 11 dental risk factors were reported, although no statistical analysis of the significance of each of these factors was possible. The clinical reach of MRONJ may be wider than anticipated, and more data on the significance of each potential risk factor are needed to guide the identification and management of at-risk patients.

Preventive dental management of osteonecrosis of the jaws related to zoledronic acid treatment

“…Currently, the effectiveness of preventive strategy is mainly focused on avoiding the known local and systemic risk factors. The few studies that evaluated the effectiveness of preventive dental treatments exhibited great variability (Bonacina et al., ; Dimopoulos et al., ; La Verde et al., ; McGowan, McGowan, & Ivanovski, ; Mücke et al., ; Ripamonti et al., ; Sim et al., ; Vandone et al., ). Generally speaking, our institutional preventive dental protocol is in agreement with those proposed by several authors in the literature.…”

Association between periodontitis and medication‐related osteonecrosis of the jaw: A systematic review and meta‐analysis

“…[48][49][50] On the other hand, the concept of at-risk patients is hindered by the difficulty in establishing risk factors. 47 Our study has several limitations. Due to the limited literature available regarding non ARs-induced MRONJ, it was not possible to analyse these subsets of drugs.…”

“…In the case of PD, risk factors are well characterized but in the case of MRONJ these remain in an ongoing debate . McGowan et al recently performed a systematic review on this matter identifying 39 different systemic diseases, 14 medical and 11 dental risk factors, thereby elucidating the complexity of this outcome . The close connection between PD and diseases which are commonly managed with ARs, independent of their consumption, and which tend to be either cancers —that particularly favour bone metastasis—, or osteoporosis, has recently been reported in observational studies, building a web of intrigue .…”

“…The close connection between PD and diseases which are commonly managed with ARs, independent of their consumption, and which tend to be either cancers —that particularly favour bone metastasis—, or osteoporosis, has recently been reported in observational studies, building a web of intrigue . On the other hand, the concept of at‐risk patients is hindered by the difficulty in establishing risk factors …”

Denosumab‐related osteonecrosis of the jaw following non‐surgical periodontal therapy: A case report

“…It has been suggested that periodontal disease is a significant triggering factor for the development of MRONJ (McGowan et al, ; Yamazaki et al., ). This possibility is of special importance in patients who receive denosumab, given in a published series, most cases of ONJ developed spontaneously, without any known triggering event like dentoalveolar surgery, ill‐fitting dentures or local trauma (Yarom et al., ).…”