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Pathophysiology of Medication-Related Osteonecrosis of the Jaw-A Minireview
Sotirios Tetradis1, Matthew R Allen2, Salvatore L Ruggiero3,4,5
1Division of Diagnostic and Surgical Sciences UCLA School of Dentistry Los Angeles CA USA.
Abstract:
Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious adverse effect of antiresorptive medications administered for control of osseous malignancy, osteoporosis, or other bone metabolic diseases. Despite being reported in the literature two decades ago, MRONJ etiology, pathophysiology, and progression remain largely unknown, and current nonoperative or operative treatment strategies are mostly empirical. Several hypotheses that attempt to explain the mechanisms of MRONJ pathogenesis have been proposed. However, none of these hypotheses alone is able to capture the complex mechanistic underpinnings of the disease. In this minireview, we aim to highlight key findings from clinical and translational studies and propose a unifying model for the pathogenesis and progression of MRONJ. We also identify aspects of the disease process that require further investigation and suggest areas for future research efforts toward calibrating methodologic approaches and validating experimental findings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Insights
Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect of bone-targeting drugs. This review proposes a unifying model for MRONJ pathogenesis and progression, highlighting areas for future research.
Area of Science:
- Oral and Maxillofacial Surgery
- Bone Metabolism
- Pharmacology
Background:
- Medication-related osteonecrosis of the jaw (MRONJ) is a rare but severe adverse effect linked to antiresorptive medications.
- Despite extensive research over two decades, the etiology, pathophysiology, and progression of MRONJ remain poorly understood.
- Current treatment strategies for MRONJ are largely empirical, underscoring the need for a deeper mechanistic understanding.
Purpose of the Study:
- To review key clinical and translational findings related to MRONJ.
- To propose a unifying model for the pathogenesis and progression of MRONJ.
- To identify knowledge gaps and suggest future research directions for MRONJ.
Main Methods:
- Literature review of clinical and translational studies on MRONJ.
- Synthesis of existing hypotheses on MRONJ pathogenesis.
- Development of a unifying model integrating current knowledge.
Main Results:
- Existing hypotheses do not fully explain the complex mechanisms underlying MRONJ.
- A unifying model is proposed to better understand MRONJ pathogenesis and progression.
- Several aspects of MRONJ require further investigation, including methodological approaches and validation of findings.
Conclusions:
- A comprehensive understanding of MRONJ requires integrating diverse findings into a unifying model.
- Future research should focus on refining methodologies and validating experimental findings to advance MRONJ understanding and treatment.
- Further investigation is crucial for developing more effective therapeutic strategies for MRONJ.
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