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

...iagnosis...

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


...d confirm the presence of all three of the...


Risk Reduction

...isk Reduction

...of CareFor cancer patients scheduled to r...


...able Risk FactorsMembers of the multi...


...lective Dentoalveolar SurgeryElective dentoalveola...


Dentoalveolar Surgery Follow-UpIf dentoalveola...


...ry Discontinuation of BMAs Prior to Dentoalveolar...


Staging

Stagin...

...stablished staging system should be used to quanti...


...ng should be performed by a clinician experienc...


Treatment

Treatment

...Treatment of MRONJConservative measures compri...


...nt of Refractory MRONJAggressive surgica...


...ary Discontinuation of BMAsFor patient...


...During the course of MRONJ treatment, the...


...s and Risk of MRONJHaving trouble...


...Proposed Terms to Characterize ONJ After Treatme...


...able 3. Descriptions of Complete, Partial and Mini...


...CC/ISOO Daily Oral Care Plan for Patien...


...5. Treatment Strategies by Stage o...


...nagement Flow Diagram...

...Consider continuation vs. dis...