Medication-related osteonecrosis of the jaw in osteoporotic patients: prevention and management

Singapore Med J. 2018 Feb;59(2):70-75. doi: 10.11622/smedj.2018014.

Abstract

Osteoporosis is a major, growing healthcare issue. This is especially of concern in an ageing population like that of Singapore. Osteoporotic patients are at risk of fractures, which can result in increased morbidity and mortality. The use of antiresorptive therapy with bisphosphonates or denosumab has been proven to reduce fracture risk. However, the use of these medications has rarely been associated with the development of osteonecrosis of the jaw, a potentially debilitating condition affecting one or both jaws. Appropriate understanding of the patient's antiresorptive therapy regime, as well as early institution of preventive dental measures, can play an important role in preventing medication-related osteonecrosis of the jaw (MRONJ). Regular monitoring and prompt referral to specialist care is warranted for patients with established MRONJ.

Keywords: MRONJ; bisphosphonates; osteonecrosis; osteoporosis.

MeSH terms

  • Aged
  • Bone Density Conservation Agents / adverse effects*
  • Bone Density Conservation Agents / therapeutic use
  • Denosumab / adverse effects
  • Denosumab / therapeutic use
  • Diphosphonates / adverse effects
  • Diphosphonates / therapeutic use
  • Humans
  • Jaw Diseases / chemically induced*
  • Jaw Diseases / prevention & control*
  • Osteonecrosis / chemically induced*
  • Osteonecrosis / prevention & control*
  • Osteoporosis / complications
  • Osteoporosis / drug therapy*
  • Osteoporotic Fractures / complications
  • Osteoporotic Fractures / drug therapy*
  • Risk Factors
  • Singapore
  • Treatment Outcome

Substances

  • Bone Density Conservation Agents
  • Diphosphonates
  • Denosumab