Medication-Related Osteonecrosis of the Jaw
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
...agnosis
...mended that the term “medication-related osteone...
...linicians should confirm the presence of all thr...
Risk Reduction
...sk Reduction
...ion of CareFor cancer patients scheduled to r...
...ble Risk FactorsMembers of the multidisciplinary...
...e Dentoalveolar SurgeryElective dentoalveolar...
...lar Surgery Follow-UpIf dentoalveolar su...
...ontinuation of BMAs Prior to Dentoalveola...
Staging
...tagin...
...ed staging system should be used to qua...
...staging should be performed by a clinician...
Treatment
...reatment
...ment of MRONJConservative measures comprise the i...
...of Refractory MRONJAggressive surgical in...
...ry Discontinuation of BMAsFor patients...
...During the course of MRONJ treatment, the dent...
...As and Risk of MRONJHaving trouble viewing table?...
...d Terms to Characterize ONJ After Trea...
...riptions of Complete, Partial and Mini...
...MASCC/ISOO Daily Oral Care Plan for PatientsHav...
Table 5. Treatment Strategies by Stage of...
...RONJ Management Flow Diagra...
...Consider...