A Clinical Study of Trigger and Prevention of Medication-related Osteonecrosis of the Jaw （MRONJ）

Abstract

Objectives: Oral management strategies for prevention of medication-related osteonecrosis of the jaw （MRONJ） in patients receiving bone-modifying agents （BMA） have not been established. Hence, we investigated the triggering events and prevention methods for MRONJ.
Methods: Eighty-six patients who developed MRONJ （33 with malignancies and 53 with osteoporosis） were examined retrospectively, focusing on the triggers for these cases.
Results: Tooth extraction was a trigger for MRONJ in 7 of 33 patients （21.2％） with malignancies, and 26 of 53 （49.1％） with osteoporosis. The occurrence of MRONJ due to tooth extraction was less frequent in the former group than in the latter because tooth extraction is typically avoided for those with malignancy as per the recommendation of a position paper. MRONJ frequently occurred in patients who underwent extraction of infected teeth, whereas no patients developed MRONJ after extraction of symptomless teeth. These findings suggest that the trigger of MRONJ is a local infection rather than surgery-related damage to the bone. Duration of BMA administration before the development of MRONJ was greater than 6months.
Conclusions: For prevention of MRONJ, we think that teeth that may be a source of infection in future should be extracted before long-term administration of BMA.