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Mechanism, prevention, and treatment for medication-related osteonecrosis of the jaws
1State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
Abstract:
The morbidity rate of medication-related osteonecrosis of the jaws (MRONJ) increased rapidly in recent years. Thusfar, the mechanism of MRONJ has no consensus. The possible mechanisms may include bone remodeling inhibition theory, angiogenesis inhibition theory, oral microorganism infection theory, immunosuppression theory, cytotoxicity-targeted oral epithelial cells, microcrack formation of maxillary or mandibular bone, and single nucleotide polymorphism. However, the efficacy of prevention and treatment based on a single mechanism is not ideal. Routine oral examination before MRONJ-related drug treatment, treatment of related dental diseases, and regular oral follow-up during drug treatment are of great significance for the prevention of MRONJ. During the treatment of MRONJ, the stage of MRONJ must be determined accurately, treatment must be standardized in accordance with the guidelines, and personalized adjustments must be made considering the specific conditions of patients. This review aimed to combine the latest research and guidelines for MRONJ and the experiences on the treatment of MRONJ in the Maxillofacial Surgery Department of West China Hospital of Stomatology, Sichuan University, and discuss the strategies to improve the clinical process.
Insights
Medication-related osteonecrosis of the jaws (MRONJ) is increasing, with no single cause identified. Effective prevention and treatment require a comprehensive approach, integrating oral care with patient-specific strategies.
Area of Science:
- Oral and Maxillofacial Surgery
- Oncology Supportive Care
- Pharmacology
Background:
- Medication-related osteonecrosis of the jaws (MRONJ) incidence is rising, posing a significant clinical challenge.
- Current understanding of MRONJ pathogenesis lacks consensus, with multiple proposed mechanisms including bone remodeling inhibition, angiogenesis inhibition, and infection.
- The limited efficacy of treatments targeting single mechanisms necessitates a re-evaluation of clinical strategies.
Purpose of the Study:
- To synthesize current research and guidelines on MRONJ prevention and treatment.
- To discuss strategies for improving the clinical management of MRONJ.
- To integrate clinical experience from West China Hospital of Stomatology for enhanced patient care.
Main Methods:
- Literature review of recent MRONJ research and clinical guidelines.
- Analysis of proposed pathogenetic mechanisms of MRONJ.
- Case experience synthesis from a specialized maxillofacial surgery department.
Main Results:
- Multiple theories contribute to MRONJ, including impaired bone remodeling, reduced angiogenesis, and altered immune response.
- Preventive measures emphasize pre-treatment oral examinations, dental disease management, and ongoing monitoring.
- Effective MRONJ treatment necessitates accurate staging, guideline adherence, and personalized therapeutic adjustments.
Conclusions:
- A multifactorial approach is crucial for both preventing and treating MRONJ.
- Standardized yet individualized treatment protocols are essential for optimal patient outcomes.
- Improved clinical processes integrating research and practice can enhance MRONJ management.
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