Analysis of potential risk factors for the development of medication-related osteonecrosis of the jaw.

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) is an undesirable consequence of the action of drugs, involving the exposure of bones in a patient not exposed to ionizing radiation in the head and neck area. The occurrence of MRONJ is associated with therapy with anti-resorptive drugs (bisphosphonates), receptor activator of nuclear factor-kappa B ligand (RANKL) drugs, e.g., denosumab, and anti-angiogenic drugs that are vascular endothelial growth factor (VEGF) inhibitors.

Objectives: The aim of the present study was to identify risk factors for the development of MRONJ.

Material and methods: The medical records of patients hospitalized in the years 2015-2022 in the Department of Maxillofacial Surgery of the Ludwik Rydygier Specialist Hospital in Krakow and the Clinical Department of Maxillofacial Surgery of University Hospital in Krakow, Poland, were retrospectively analyzed. The study included patients treated for MRONJ in the maxilla and/or the mandible with a history of past bisphosphonate therapy. Patients with symptoms of osteonecrosis after radiotherapy of the head and neck region were excluded from the study. The patients' demographic data, comorbidities, the initial disease treated with bisphosphonates, the route of drug administration, the type of causative dental surgery, the area of necrosis, and the MRONJ class according to the American Association of Oral and Maxillofacial Surgeons (AAOMS) criteria were analyzed.

Results: The investigated group consisted of 29 females and 14 males. Common comorbidities were anemia, diabetes mellitus (DM) and hypertension. Bisphosphonates were used in 30 patients (69.8%) treated for cancer, in 10 patients (23.3%) treated for osteoporosis and in 2 patients (4.7%) treated for osteopenia. In the majority of cases (n = 19; 44.2%), bisphosphonates were administrated intravenously. Medication-related osteonecrosis of the jaw was diagnosed in the mandible in 25 cases (58.1%) and in 18 (41.9%) - in the maxilla. In 14 patients (32.6%), necrosis was initiated by a dental procedure, most often tooth extraction.

Conclusions: Risk factors for the development of MRONJ in patients treated with bisphosphonates include the intravenous route of drug administration, past intraoral surgery, female gender, and senior age.