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Infection as an Important Factor in Medication-Related Osteonecrosis of the Jaw (MRONJ)
Sven Otto1,2, Suad Aljohani3, Riham Fliefel2,4,5
1Head of Department of Oral and Maxillofacial Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany.
Abstract:
Medication-related osteonecrosis of the jaw (MRONJ) has become a well-known side effect of antiresorptive, and antiangiogenic drugs commonly used in cancer management. Despite a considerable amount of literature addressing MRONJ, it is still widely accepted that the underlying pathomechanism of MRONJ is unclear. However, several clinical and preclinical studies indicate that infection seems to have a major role in the pathogenesis of MRONJ. Although there is no conclusive evidence for the infection hypothesis yet, available data have shown a robust association between local infection and MRONJ development. This observation is very critical in order to implement policies to reduce the risk of MRONJ in patients under antiresorptive drugs. This critical review was conducted to collect the most reliable evidence regarding the link between local infection and MRONJ pathogenesis.
Insights
Medication-related osteonecrosis of the jaw (MRONJ) is a side effect of cancer drugs. Emerging evidence suggests local infection plays a significant role in MRONJ development, crucial for risk reduction strategies.
Area of Science:
- Oral and Maxillofacial Surgery
- Oncology
- Pharmacology
Background:
- Medication-related osteonecrosis of the jaw (MRONJ) is a recognized adverse effect of antiresorptive and antiangiogenic therapies.
- The precise pathogenesis of MRONJ remains incompletely understood despite extensive research.
- These medications are frequently utilized in managing various cancer types.
Purpose of the Study:
- To critically review existing evidence linking local infection to MRONJ pathogenesis.
- To consolidate findings that support the role of infection in MRONJ development.
- To inform the development of risk-reduction strategies for patients receiving these medications.
Main Methods:
- Comprehensive literature search for clinical and preclinical studies.
- Critical appraisal of evidence regarding the association between infection and MRONJ.
- Synthesis of data to evaluate the infection hypothesis in MRONJ pathogenesis.
Main Results:
- Several studies indicate a significant association between local infection and MRONJ.
- Preclinical and clinical data suggest infection is a major factor in MRONJ development.
- While not definitively proven, the link between infection and MRONJ is robust.
Conclusions:
- Local infection appears to be a critical factor in the pathogenesis of MRONJ.
- Understanding this link is vital for implementing effective preventive measures.
- Further research is warranted to confirm the role of infection and guide clinical practice.
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