Medication-Related Osteonecrosis of the Jaw: An Evidence-Based 2025 Position Statement from a Korean...

Area of Science:

• Oral and Maxillofacial Surgery
• Endocrinology
• Bone and Mineral Research

Background:

• Medication-related osteonecrosis of the jaw (MRONJ) is a growing global challenge due to aging populations and increased antiresorptive agent use.
• Existing clinical guidance requires tailoring to specific healthcare environments, necessitating a multidisciplinary approach.

Purpose of the Study:

• To develop evidence-based clinical guidelines for MRONJ prevention, diagnosis, and management specific to the Korean healthcare setting.
• To standardize MRONJ care, reduce clinical confusion, and improve patient outcomes through a clear decision-making framework.

Main Methods:

• A multidisciplinary task force involving five Korean academic societies was convened.
• Consensus was achieved through comprehensive literature reviews and three rounds of expert opinion surveys on controversial topics.
• Guidelines were developed for diagnostic criteria, staging, prophylactic and therapeutic drug holidays, and treatment strategies.

Main Results:

• Diagnostic criteria affirm the standard definition, allowing diagnosis based on clinical/radiographic evidence even if the 8-week timeframe is unmet.
• Stage 0 is retained for early detection and prevention; drug-specific prophylactic drug holidays (e.g., 2 months for oral bisphosphonates) are recommended.
• Early and active surgical intervention is advocated across all MRONJ stages, supported by evidence of superior long-term outcomes.

Conclusions:

• This position statement provides a unique, evidence-based Korean clinical practice guideline for MRONJ management.
• Key recommendations focus on optimizing drug holidays and promoting early surgical treatment to mitigate MRONJ risks and improve patient care.