Updates on medication - Related osteonecrosis of the jaws

 Medication-related osteonecrosis of the jaws (MRONJ) is a severe complication that manifests with many possible clinical signs and symptoms, including exposed bone, fistula, inflammation with or without suppuration, ulcers, soft and hard tissue necrosis, and edema. In the majority of cases, MRONJ manifests as exposed bone in the maxillofacial region, although non-exposed MRONJ has also been recognized

 MRONJ is a drug-related complication, observed in patients receiving mainly agents with antiresorptive and antiangiogenic properties. 

Since the first cases of MRONJ were reported, significant progress has been made in understanding the pathophysiology of the disease but still the pathophysiology of MRONJ has not been fully clarified. Different hypotheses have been proposed to explain the pathogenesis of this complication.

The primary parameter to be considered for the development of MRONJ, is the therapeutic indication for treatment (eg, malignancy or osteoporosis/osteopenia). The etiology of MRONJ is multifactorial as a result of the association of metabolic, local and genetic factors. The most reported dental risk factor is tooth extraction, followed by periodontal disease while chemotherapy and corticosteroids are the most frequently reported medical risk factors. 

Staging and treatment guidelines have been proposed however, there has been no universal acceptance, and clinicians rely on various position papers. The major treatment objectives for patients with MRONJ are pain and infection control and minimization of ONJ progression. Strategies for management of patients at risk for or with MRONJ will be discussed.

The lecture aims to provide an update regarding definition, staging, pathophysiology, risk factors and treatment strategies of medication-related osteonecrosis of the jaws.