Medication-related osteonecrosis of the jaw (MRONJ): an update on the Memorial Sloan Kettering Cancer Center (MSKCC) experience and the role of pre-medication dental evaluation in the prevention of MRONJ

Publication date: Available online 14 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Adepitan A. Owosho, See Toh Yoong Liang, Adi Z. Sax, Kant Wu, SaeHee K. Yom, Joseph M. Huryn, Cherry L. Estilo
Objective.We aim to investigate the relationship between type of antiresorptive medication and MRONJ onset and the role of pre-medication dental evaluation (PMDE) in the prevention of MRONJ.Study Design.Our database of MRONJ patients was reviewed. Kruskal-Wallis test was used to analyze the onset dose of the three frequent medication types associated with MRONJ. To evaluate the role of PMDE in the prevention of MRONJ, all patients on anti-resorptive and/or anti-angiogenic medications (A/A) seen in the Dental Service of MSKCC during a 10-year period were sub-classified into two groups. Group I, patients seen for PMDE before the commencement of A/A and Group II, patients seen after prior exposure to A/A. Fischer's exact test was used to compare the incidence of MRONJ in both groups.Results.Patients on denosumab developed MRONJ earlier compared to zoledronate and pamidronate (p=0.003). Group I had a significantly reduced incidence of MRONJ (0.9%) compared to Group II (10.5%) (p<0.0001). Dentoalveolar trauma as a precipitating factor between Groups I and II was not statistically significant.Conclusions.Denosumab was associated with an earlier occurrence of MRONJ compared to zoledronate and pamidronate. The role of PMDE may be an effective preventive strategy in reducing the incidence of MRONJ.



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