Medication-related osteonecrosis of the jaw: A disease of significant importance for older patients

Bridget Boston; Deepak Ipe; Bogdan Capitanescu; Andrei Gresita; Stephen Hamlet; Robert Love; Michael Hadjiargyrou; Chien-Ling Huang; Iulian Nusem; Rodica Ileana Miroiu; Aurel Popa-Wagner; Patrick Hans-Heinrich Warnke; Eugen Bogdan Petcu

doi:10.1111/jgs.18414

Medication-related osteonecrosis of the jaw: A disease of significant importance for older patients

J Am Geriatr Soc. 2023 Aug;71(8):2640-2652. doi: 10.1111/jgs.18414. Epub 2023 May 24.

Authors

Affiliations

¹ Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia.
² Department Anatomy, University of Medicine, and Pharmacy, Craiova, Romania.
³ Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, New York, USA.
⁴ Department of Biological and Chemical Sciences, New York Institute of Technology, Old Westbury, New York, USA.
⁵ Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China.
⁶ Department of Orthopaedic Surgery, Logan Hospital, Meadowbrook, Queensland, Australia.
⁷ Queensland Bone Bank, Coopers Plains, Queensland, Australia.
⁸ Experimental Research Center for Normal and Pathological Aging, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
⁹ Department of Oral and Maxillofacial Surgery, University of Kiel and Praxisklinik am Ballastkai, Flensburg, Germany.

PMID: 37224415
DOI: 10.1111/jgs.18414

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) is clinically defined as a non-healing jawbone ulcerative-necrotic lesion appearing after dental therapy or minor trauma in patients treated previously with anti-resorptive, anti-angiogenic or immunomodulators. Older patients with osteoporosis and cancer receive these pharmacological agents regularly. As these patients are long-term survivors, efficient treatment is of paramount importance for their quality of life.

Methods: Literature searches via PubMed were conducted to identify relevant MRONJ studies. Basic information on MRONJ classification, clinical features, and pathosphysiology is presented herein as well as various clinical studies dealing with MRONJ in patients with osteoporosis and cancer. Lastly, we discuss current managment of patients and new trends in treatment of MRONJ.

Results: Although close follow-up and local hygiene have been advocated by some authors, severe forms of MRONJ are not responsive to conservative therapy. At present, there is no "gold standard" therapy for this condition. However, as the physiopathological basis of MRONJ is represented by the anti-angiogenic action of various pharmacological agents, new methods to increase and promote local angiogenesis and vascularization have recently been successfully tested in vitro, limited preclinical studies, and in a pilot clinical study.

Conclusions: It appears that the best method implies application on the lesion of endothelial progenitor cells as well as pro-angiogenic factors such as Vascular Endothelial Growth Factor (VEGF) and other related molecules. More recently, scaffolds in which these factors have been incorporated have shown positive results in limited trials. However, these studies must be replicated to include a large number of cases before any official therapeutic protocol is adopted.

Keywords: MRONJ; bisphosphonates; bone resorption; denosumab; osteoporosis.

Publication types

Review

MeSH terms

Bisphosphonate-Associated Osteonecrosis of the Jaw* / drug therapy
Bone Density Conservation Agents* / adverse effects
Diphosphonates / adverse effects
Humans
Neoplasms* / drug therapy
Osteoporosis* / drug therapy
Quality of Life
Vascular Endothelial Growth Factor A / therapeutic use

Substances

Diphosphonates
Bone Density Conservation Agents
Vascular Endothelial Growth Factor A