Related Experiment Video
Updated: Sep 13, 2025
Osteoclast Derivation from Mouse Bone Marrow
Published on: November 6, 2014
Radiologic and Pathologic Insights into Medication-Related Osteonecrosis of the Jaw in Myeloma Patients: A Report of
Suvarna Indermun1, Jessica Simpson1, Kim Pedro-Beech2
1Department of Craniofacial Biology, Pathology and Radiology, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa.
Abstract:
Medication-related osteonecrosis of the jaw (MRONJ) is a rare side-effect of certain drugs, mainly those used in regimens treating specific cancers and in the initial treatment for non-neoplastic conditions. The first cases of jaw osteonecrosis were reported over 2 decades ago in patients taking bisphosphonates (BPs). Since its identification, the nomenclature has changed from bisphosphonate-related osteonecrosis of the jaw (BRONJ) to MRONJ, as other drugs can elicit the same reaction. Invasive dental treatments, such as extractions, are known risk factors. Therefore, the importance of routine dental care before and during such drug therapy cannot be overemphasized. MRONJ is a challenging condition to diagnose early as the radiographic features are subtle and easily overlooked. This case report presents 3 female patients with multiple myeloma, emphasizing the chronological radiologic evolution of MRONJ. Notably, 1 case illustrates a transition from Stage 0 to Stage 2 over a 17-month period, documented through serial panoramic radiographs and a positron emission tomography (PET) scan. Another case highlights the role of cone beam computed tomography (CBCT) in identifying sequestra and pathological fractures. An additional noteworthy case illustrates that conservative dental management avoided the potential development of MRONJ. While histopathology confirmed necrotic bone in 2 cases, early radiologic indicators such as sclerosis and nonhealing sockets provided key diagnostic insights. This case report underscores the importance of regular dental monitoring and interdisciplinary care in at-risk patients and contributes to the growing discourse on the critical role of radiologic evaluation in the early detection and management of MRONJ.
Insights
Medication-related osteonecrosis of the Jaw (MRONJ) is a rare side-effect of certain drugs. Early radiologic indicators and dental monitoring are crucial for timely diagnosis and management of MRONJ.
Area of Science:
- Oral and Maxillofacial Surgery
- Oncology
- Radiology
Background:
- Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse effect of medications used for cancer and non-neoplastic conditions.
- Bisphosphonates (BPs) were initially linked to this condition, but other drugs can also cause it, leading to the updated nomenclature MRONJ.
- Invasive dental procedures are identified risk factors, highlighting the necessity of dental care before and during MRONJ-associated drug therapy.
Observation:
- This case report details the radiographic progression of MRONJ in three female patients with multiple myeloma.
- One patient showed a progression from Stage 0 to Stage 2 MRONJ over 17 months, documented by serial panoramic radiographs and PET scans.
- Cone beam computed tomography (CBCT) proved effective in detecting sequestra and pathological fractures, while conservative dental management prevented MRONJ development in another case.
Findings:
- Early radiographic signs of MRONJ include sclerosis and nonhealing sockets, even when histopathology confirms necrotic bone.
- Serial imaging, including panoramic radiography and CBCT, is vital for tracking MRONJ evolution and identifying complications.
- Positron emission tomography (PET) scans can aid in assessing the extent and progression of MRONJ.
Implications:
- This report emphasizes the critical role of regular dental monitoring and interdisciplinary collaboration for patients at risk of MRONJ.
- Enhanced radiologic evaluation is essential for the early detection and effective management of MRONJ.
- Understanding the chronological radiologic evolution of MRONJ aids clinicians in diagnosis and treatment planning.
Related Concept Videos
01:31Osteoclasts in Bone Remodeling
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...