Medication-Related Osteonecrosis of the Jaw

Publication Date: July 22, 2019

Key Points

Key Points

Medication-related osteonecrosis of the jaw (MRONJ) is defined as exposed bone or bone that can be probed through one or more intraoral or extraoral fistulae in the maxillofacial region and that does not heal within 8 weeks, occurring in a patient who has received a bone-modifying agent (BMA) or an angiogenic inhibitor agent and has no history of head and neck radiation.

The condition may involve the mandible or the maxilla.

BMAs that have been linked with MRONJ principally include bisphosphonates and denosumab.

BMAs are a key component of the management of patients with cancer with skeletal metastases.

These medications provide a number of clinical benefits, including a reduced incidence of skeletal-related events (e.g., pathologic fractures and spinal cord compression) and reduced need for radiation or surgery to bone.

Use of BMAs is associated with MRONJ, which occurs in approximately 1–9% of patients with advanced cancer.

This pocket guide focuses on the prevention and management of MRONJ in patients with cancer who receive BMAs for oncologic indications.

The pocket guide does not address BMAs used for osteoporosis, which are administered at a lower dose and carry a lower risk for MRONJ, nor does the pocket guide address the prevention or management of MRONJ due to medications other than BMAs.

Diagnosis

...d that the term “medication-related o...


...linicians should confirm the presence of all three...


Risk Reduction

...Risk R...

...tion of CareFor cancer patients scheduled t...


...iable Risk FactorsMembers of the mu...


...Dentoalveolar SurgeryElective dentoal...


...r Surgery Follow-UpIf dentoalveola...


...ontinuation of BMAs Prior to Dentoalveolar...


Staging

...Staging...

...ell-established staging system should be u...


...ly, staging should be performed by a c...


Treatment

...Tre...

Initial Treatment of MRONJConserva...


...efractory MRONJAggressive surgical interve...


Temporary Discontinuation of BMAsFor p...


...MeasuresDuring the course of MRONJ treatment, the...


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...oposed Terms to Characterize ONJ After...


...tions of Complete, Partial and Minimal...


...le 4. MASCC/ISOO Daily Oral Care Plan for P...


...able 5. Treatment Strategies by Stage of MR...


...NJ Management Flow D...

...Consider continuation...