Medication-related osteonecrosis of the jaw: knowledge and perceptions of medical professionals on the usage of bone modifying agents and dental referrals

J Med Life. 2022 Mar;15(3):368-373. doi: 10.25122/jml-2021-0085.

Abstract

Bone modifying agents (BMA) like bisphosphonates, antiangiogenic, and antiresorptive agents are widely used to manage bone diseases and cancer. Medication-related osteonecrosis of the jaw (MRONJ) is a potentially serious complication seen in patients on BMA therapy. Dental infection is one of the primary risk factors for MRONJ manifestation; hence its complete removal before initiation of BMA is significant. This can be achieved when a medical professional understands MRONJ and its risk factors and implements timely and regular dental referrals. This multicentre study was performed to assess the knowledge about MRONJ and awareness about the implementation of dental referrals among medical professionals. A custom-designed questionnaire tool was designed and validated by a pilot study. 450 practitioners from 6 medical schools and private practitioners in and around the district were surveyed. The results were analyzed using descriptive statistics. 63.5% (n=80) of the respondents prescribed bisphosphonates at a frequency of 0-5 times in a month. However, 62% (n=78) of the practitioners could correctly indicate the most appropriate definition of MRONJ. Only 49.2% (n=62) of them considered dental consultation mandatory. 73% (n=92) of the practitioners were unaware of management guidelines. There exists a significant gap in the knowledge-based applications in the management of MRONJ. Lack of referrals to dentists before BMA therapy can be a pivotal factor in patient morbidity. Practitioners prescribing BMA should advise patients about regular dental visits and monitor for symptoms of MRONJ.

Keywords: BMA – Bone modifying agents; BRONJ – Bisphosphonate-related osteonecrosis of the jaw; IV – Intravenous therapy; MRONJ – Medication-related osteonecrosis of the jaw; SRE –Skeletal Related Events; angiogenic inhibitor; antiresorptive agents; awareness; bisphosphonates; osteonecrosis.

Publication types

  • Multicenter Study

MeSH terms

  • Bisphosphonate-Associated Osteonecrosis of the Jaw* / diagnosis
  • Bisphosphonate-Associated Osteonecrosis of the Jaw* / etiology
  • Bisphosphonate-Associated Osteonecrosis of the Jaw* / therapy
  • Bone Density Conservation Agents* / adverse effects
  • Diphosphonates / adverse effects
  • Humans
  • Pilot Projects
  • Referral and Consultation

Substances

  • Bone Density Conservation Agents
  • Diphosphonates