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Medication-related osteonecrosis of the jaw in multiple myeloma patients: a case series

Louis Madden1, Dermot Pierse2

  • 1Division of Oral and Maxillofacial Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Dublin Dental University Hospital, Trinity College, Ireland; Department of Oral and Maxillofacial Surgery, University Hospital Galway, Galway, Ireland. Louis.Madden@hse.ie.

British Dental Journal
|July 10, 2026
PubMed

Insights

Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication for multiple myeloma patients undergoing antiresorptive therapy (ART). Early dental intervention and multidisciplinary care are crucial for preventing and managing this condition.

Area of Science:

  • Oncology
  • Oral and Maxillofacial Surgery
  • Pharmacology

Background:

  • Medication-related osteonecrosis of the jaw (MRONJ) is a significant complication associated with antiresorptive and anti-angiogenic therapies used in cancer management.
  • Multiple myeloma (MM) patients frequently develop osteolytic bone disease and are often treated with antiresorptive therapy (ART), increasing their risk of MRONJ.
  • MRONJ can lead to substantial functional impairment and aesthetic concerns for patients.

Purpose of the Study:

  • To present the clinical characteristics and management strategies for four cases of MRONJ in multiple myeloma patients.
  • To contextualize these cases within the current body of evidence regarding MRONJ in malignancy.
  • To highlight the critical role of dental practitioners and multidisciplinary collaboration in MRONJ prevention and management.

Main Methods:

  • Retrospective case series analysis of four MM patients diagnosed with MRONJ at Dublin Dental University Hospital (2021-2023).
  • Review of clinical presentations, ranging from localized exposed bone to severe jaw destruction.
  • Analysis of implicated medications, risk factors, prognostic indicators, and treatment outcomes.

Main Results:

  • The four cases demonstrated a spectrum of MRONJ severity in MM patients undergoing ART.
  • MRONJ management proved challenging due to the condition's refractory nature.
  • Prevention through comprehensive dental care before, during, and after ART is essential.

Conclusions:

  • Multidisciplinary collaboration between dental and oncology teams is vital for improving outcomes in MM patients at risk of MRONJ.
  • Timely diagnosis and proactive risk reduction strategies are paramount in minimizing MRONJ-related complications.
  • Dental practitioners play a pivotal role in the prevention and management of MRONJ in patients receiving antiresorptive therapies.

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