Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline Summary.

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is defined as exposed bone or bone that can be probed through an intraoral or extraoral fistula (or fistulae) in the maxillofacial region and that does not heal within 8 weeks, occurring in a patient who has received a bone-modifying agent (BMA) or an angiogenic inhibitor agent and with no history of head and neck radiation. The condition may involve the mandible or the maxilla. BMAs that have been linked with MRONJ principally include bisphosphonates and denosumab. BMAs are a key component of the management of patients with cancer with skeletal metastases or multiple myeloma. These medications provide a number of clinical benefits, including a reduced incidence of skeletal-related events (eg, pathologic fractures and spinal cord compression) and reduced need for radiation or surgery to bone. Use of BMAs is associated with MRONJ, which can be challenging to treat and can cause significant pain and reduced quality of life. Many studies have established that preventive oral care methods alongside effective oral health practices are associated with a lower rate of MRONJ.