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[Research progress in the pathogenesis of medication-related osteonecrosis of the jaw based on immune-vascular
1State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
Abstract:
The pathogenesis of medication-related osteonecrosis of the jaw (MRONJ) is complex, and the traditional bone remodeling inhibition theory cannot fully explain its pathological evolution. From a microenvironmental perspective, this review systematically reviews the critical role of "immune-vascular coupling" dysfunction in MRONJ. Long-term exposure to anti-resorptive drugs induces phenotypic polarization imbalance, metabolic disorders, and impaired efferocytosis in local macrophages, triggering persistent inflammation. Simultaneously, these drugs not only exert direct toxicity on endothelial cells but also disrupt vascular regeneration and drainage through abnormal intercellular communication. The combination of immune dysregulation and vascular degeneration ultimately leads to the failure of coordinated soft and hard tissue repair. This article aims to provide a systematic reference for the mechanistic understanding and targeted prevention and treatment of MRONJ.
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