Osteoporosis medication exposure patterns and MRONJ occurrence in patients receiving romosozumab: a retrospective...

To characterize invasive dental procedures in romosozumab-treated osteoporosis patients and describe medication-related osteonecrosis of the jaw (MRONJ) according to exposure timing.

This retrospective study used electronic medical records and prescription/administration data from Yonsei University Dental Hospital between 2019 and 2024. Participants who received romosozumab, underwent tooth extraction and/or implant placement, and had at least 6 months of follow-up were included. Invasive dental procedures were categorized according to the timing of romosozumab administration relative to dental treatment (before, after, or both before and after treatment). MRONJ was identified according to American Association of Oral and Maxillofacial Surgeons criteria. Analyses were descriptive.

A total of 201 participants underwent 303 invasive procedures (231 extractions, 72 implants). Extractions were most commonly performed for retained root (30.3%), caries (22.1%), periodontal disease (19.0%), and fractures (11.7%). Among the procedures, 77 (25.4%) were categorized as before dental treatment, 182 (60.1%) as after dental treatment, and 44 (14.5%) as before and after dental treatment relative to romosozumab administration. One case of MRONJ occurred in a participant with sequential exposure to denosumab, romosozumab, and subsequent intravenous zoledronic acid therapy, accompanied by local infection.

A causal relationship with romosozumab monotherapy could not be determined because MRONJ occurred during cumulative and sequential antiresorptive exposure with local infection. Larger studies are needed to assess risks related to treatment sequence and cumulative exposure.

Clinicians managing patients receiving romosozumab should consider cumulative antiresorptive exposure, local infection, and close coordination between physicians and dentists.