Your browser does not fully support modern features. Please upgrade for a smoother experience.
Submitted Successfully!
Thank you for your contribution! You can also upload a video entry or images related to this topic. For video creation, please contact our Academic Video Service.
Version Summary Created by Modification Content Size Created at Operation
1 handwiki Vivi Li -- 3798 2022-10-12 01:31:34

Video Upload Options

We provide professional Academic Video Service to translate complex research into visually appealing presentations. Would you like to try it?
Cite
If you have any further questions, please contact Encyclopedia Editorial Office.
HandWiki. Medication-associated Osteonecrosis of the Jaw. Encyclopedia. Available online: https://encyclopedia.pub/entry/30171 (accessed on 25 September 2026).
HandWiki. Medication-associated Osteonecrosis of the Jaw. Encyclopedia. Available at: https://encyclopedia.pub/entry/30171. Accessed September 25, 2026.
HandWiki. "Medication-associated Osteonecrosis of the Jaw" Encyclopedia, https://encyclopedia.pub/entry/30171 (accessed September 25, 2026).
HandWiki. (2022, October 19). Medication-associated Osteonecrosis of the Jaw. In Encyclopedia. https://encyclopedia.pub/entry/30171
HandWiki. "Medication-associated Osteonecrosis of the Jaw." Encyclopedia. Web. 19 October, 2022.
Medication-associated Osteonecrosis of the Jaw
Edit

Medication-related osteonecrosis of the jaw (MON, MRONJ) is progressive death of the jawbone in a person exposed to a medications known to increase the risk of disease, in the absence of a previous radiation treatment. It may lead to surgical complication in the form of impaired wound healing following oral and maxillofacial surgery, periodontal surgery, or endodontic therapy. Particular medications can result in MRONJ, a serious but uncommon side effect in certain individuals. Such medications are frequently used to treat diseases that cause bone resorption such as osteoporosis, or to treat cancer. The main groups of drugs involved are anti-resorptive drugs, and anti-angiogenic drugs. This condition was previously known as bisphosphonate-related osteonecrosis of the jaw because osteonecrosis of the jaws correlating with bisphosphate treatment was frequently encountered, with its first incident occurring in 2003. Denosumab, another antiresorptive drug were also related to this condition. However, newer medications such as anti-angiogenic drugs has been established over the years which were reported to be related to osteonecrosis of the jaw as a side-effect too, hence this condition has been renamed as MRONJ. BON was been nicknamed "bis-phossy jaw" based on its similarity with phossy jaw. There is no known prevention for bisphosphonate-associated osteonecrosis of the jaw. Avoiding the use of bisphosphonates is not a viable preventive strategy on a general-population basis because the medications are beneficial in the treatment and prevention of osteoporosis (including prevention of bony fractures) and treatment of bone cancers. It usually develops after dental treatments involving exposure of bone or trauma, or may arise spontaneously. Patients who develop MRONJ may experience prolonged healing, pain, swelling, infection, exposed bone, after dental procedures, though some patients may have no signs/symptoms.

osteonecrosis of the jaw dental treatments osteonecrosis

References

  1. Dodson, TB (2015). "The frequency of medication-related ssteonecrosis of the jaw and its associated risk factors". Oral and Maxillofacial Surgery Clinics of North America 27 (4): 509–16. doi:10.1016/j.coms.2015.06.003. PMID 26362367.  https://dx.doi.org/10.1016%2Fj.coms.2015.06.003
  2. "Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw". Scottish Dental Clinical Effectiveness Programme. March 2017. http://www.sdcep.org.uk/wp-content/uploads/2017/04/SDCEP-Oral-Health-Management-of-Patients-at-Risk-of-MRONJ-Guidance-full.pdf. 
  3. Ruggiero SL, Dodson TB, Fantasia J, et al. (2014). "American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw - 2014 update.". Journal of Oral and Maxillofacial Surgery 72 (10): 1938–1956. doi:10.1016/j.joms.2014.04.031. PMID 25234529.  https://dx.doi.org/10.1016%2Fj.joms.2014.04.031
  4. Marx RE (September 2003). "Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic". J. Oral Maxillofac. Surg. 61 (9): 1115–7. doi:10.1016/S0278-2391(03)00720-1. PMID 12966493. http://linkinghub.elsevier.com/retrieve/pii/S0278239103007201. 
  5. Migliorati CA (November 2003). "Bisphosphanates and oral cavity avascular bone necrosis". J. Clin. Oncol. 21 (22): 4253–4. doi:10.1200/JCO.2003.99.132. PMID 14615459. http://www.jco.org/cgi/pmidlookup?view=long&pmid=14615459. 
  6. Appendix 11: Expert Panel Recommendation for the Prevention, Diagnosis and Treatment of Osteonecrosis of the Jaw http://www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4095B2_02_12-Novartis-Zometa-App-11.htm
  7. "Bisphosphonate-induced osteonecrosis of the jaws, bone markers, and a hypothesized candidate gene". J. Oral Maxillofac. Surg. 67 (1): 159–61. January 2009. doi:10.1016/j.joms.2008.09.015. PMID 19070762. http://linkinghub.elsevier.com/retrieve/pii/S0278-2391(08)01493-6. 
  8. Ruggiero SL (March 2008). "Bisphosphonate-related Osteonecrosis of the Jaws". Compendium of Continuing Education in Dentistry 29 (2): 97–105. 
  9. Allen, Matthew R.; Ruggiero, Salvatore L. (2009-07-01). "Higher bone matrix density exists in only a subset of patients with bisphosphonate-related osteonecrosis of the jaw". Journal of Oral and Maxillofacial Surgery 67 (7): 1373–1377. doi:10.1016/j.joms.2009.03.048. ISSN 1531-5053. PMID 19531405.  https://dx.doi.org/10.1016%2Fj.joms.2009.03.048
  10. Khan, Aliya A.; Morrison, Archie; Hanley, David A.; Felsenberg, Dieter; McCauley, Laurie K.; O'Ryan, Felice; Reid, Ian R.; Ruggiero, Salvatore L. et al. (2015-01-01). "Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus". Journal of Bone and Mineral Research 30 (1): 3–23. doi:10.1002/jbmr.2405. ISSN 1523-4681. PMID 25414052.  https://dx.doi.org/10.1002%2Fjbmr.2405
  11. "Painful trigeminal neuropathy induced by oral bisphosphonate-related osteonecrosis of the jaw: a new etiology for the numb-chin syndrome". Quintessence Int. 43 (2): 97–104. February 2012. PMID 22257870. http://www.quintpub.com/journals/qi/abstract.php?iss2_id=1012&article_id=11722&article=3&title=Painful+trigeminal+neuropathy+induced+by+oral+bisphosphonate%EF%BF%BDrelated+osteonecrosis+of+the+jaw%3A+A+new+etiology+for+the+numb-chin+syndrome#.UGfs5ZjA_IZ. 
  12. Sharma, Dileep; Ivanovski, Saso; Slevin, Mark; Hamlet, Stephen; Pop, Tudor S.; Brinzaniuc, Klara; Petcu, Eugen B.; Miroiu, Rodica I. (2013-01-01). "Bisphosphonate-related osteonecrosis of jaw (BRONJ): diagnostic criteria and possible pathogenic mechanisms of an unexpected anti-angiogenic side effect". Vascular Cell 5 (1): 1. doi:10.1186/2045-824X-5-1. ISSN 2045-824X. PMID 23316704.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3606312
  13. Goodell, Dr. Gary G. (Fall 2012). "Endodontics: Colleagues for Excellence". 211 E. Chicago Ave., Suite 1100 Chicago, IL 60611-2691: American Association of Endodontists. https://www.aae.org/uploadedfiles/publications_and_research/endodontics_colleagues_for_excellence_newsletter/fall2012ecfe.pdf. 
  14. Otto, Sven; Hafner, Sigurd; Grötz, Knut A. (2009-03-01). "The role of inferior alveolar nerve involvement in bisphosphonate-related osteonecrosis of the jaw". Journal of Oral and Maxillofacial Surgery 67 (3): 589–592. doi:10.1016/j.joms.2008.09.028. ISSN 1531-5053. PMID 19231785.  https://dx.doi.org/10.1016%2Fj.joms.2008.09.028
  15. Baron, Roland; Ferrari, Serge; Russell, R. Graham G. (2011-04-01). "Denosumab and bisphosphonates: different mechanisms of action and effects". Bone 48 (4): 677–692. doi:10.1016/j.bone.2010.11.020. ISSN 1873-2763. PMID 21145999.  https://dx.doi.org/10.1016%2Fj.bone.2010.11.020
  16. Russell, R. G. G.; Watts, N. B.; Ebetino, F. H.; Rogers, M. J. (2008-06-01). "Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy". Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 19 (6): 733–759. doi:10.1007/s00198-007-0540-8. ISSN 0937-941X. PMID 18214569.  https://dx.doi.org/10.1007%2Fs00198-007-0540-8
  17. Lindsay R, Cosman F. Osteoporosis. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison’s principles of internal medicine. New York:McGraw-Hill, 2001:2226-37.
  18. Wood, J; Bonjean, K; Ruetz, S; Bellahcene, A; Devy, L; Foidart, JM; Castronovo, V; Green, JR (2002). "Novel antiangiogenic effects of the bisphosphonate compound zoledronic acid". J Pharmacol Exp Ther 302 (3): 1055–61. doi:10.1124/jpet.102.035295. PMID 12183663.  https://dx.doi.org/10.1124%2Fjpet.102.035295
  19. Vincenzi, B; Santini, D; Dicuonzo, G; Battistoni, F; Gavasci, M; La Cesa, A; Grilli, C; Virzi, V et al. (2005). "Zoledronic acid-related angiogenesis modifications and survival in advanced breast cancer patients". J Interferon Cytokine Res 25 (3): 144–51. doi:10.1089/jir.2005.25.144. PMID 15767788.  https://dx.doi.org/10.1089%2Fjir.2005.25.144
  20. Santini, D; Vincenzi, B; Dicuonzo, G; Avvisati, G; Massacesi, C; Battistoni, F; Gavasci, M; Rocci, L et al. (2003). "Zoledronic acid induces significant and long-lasting modifications of circulating angiogenic factors in cancer patients". Clin Cancer Res 9 (8): 2893–7. PMID 12912933.  http://www.ncbi.nlm.nih.gov/pubmed/12912933
  21. Chapurlat, Roland D; Arlot, Monique; Burt-Pichat, Brigitte; Chavassieux, Pascale; Roux, Jean Paul; Portero-Muzy, Nathalie; Delmas, Pierre D (2007-10-01). "Microcrack Frequency and Bone Remodeling in Postmenopausal Osteoporotic Women on Long-Term Bisphosphonates: A Bone Biopsy Study" (in en). Journal of Bone and Mineral Research 22 (10): 1502–1509. doi:10.1359/jbmr.070609. ISSN 1523-4681. PMID 17824840.  https://dx.doi.org/10.1359%2Fjbmr.070609
  22. Stepan, Jan J.; Burr, David B.; Pavo, Imre; Sipos, Adrien; Michalska, Dana; Li, Jiliang; Fahrleitner-Pammer, Astrid; Petto, Helmut et al. (2007-09-01). "Low bone mineral density is associated with bone microdamage accumulation in postmenopausal women with osteoporosis". Bone 41 (3): 378–385. doi:10.1016/j.bone.2007.04.198. ISSN 8756-3282. PMID 17597017.  https://dx.doi.org/10.1016%2Fj.bone.2007.04.198
  23. Woo, Sook-Bin; Hellstein, John W.; Kalmar, John R. (2006-05-16). "Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws". Annals of Internal Medicine 144 (10): 753–761. doi:10.7326/0003-4819-144-10-200605160-00009. ISSN 1539-3704. PMID 16702591.  https://dx.doi.org/10.7326%2F0003-4819-144-10-200605160-00009
  24. Osteoporosis medications and your dental health pamphlet #W418, American Dental Association/National Osteoporosis Foundation, 2008
  25. Medical News Today AAOMS Updates BRONJ Position Paper, January 23, 2009 http://www.medicalnewstoday.com/articles/136380.php
  26. American Dental Association Osteonecrosis of the Jaw http://www.ada.org/prof/resources/topics/osteonecrosis.asp
  27. "Osteonecrosis of the jaw (ONJ) and drug treatments for osteoporosis". The National Osteoporosis Society. https://nos.org.uk/media/1593/k-drug-treatments-for-osteoporosis-osteonecrosis-of-the-jaw-onj-_.pdf. 
  28. "Incidence of osteonecrosis of the jaw in women with postmenopausal osteoporosis in the health outcomes and reduced incidence with zoledronic acid once yearly pivotal fracture trial". J Am Dent Assoc 139 (1): 32–40. January 2008. doi:10.14219/jada.archive.2008.0017. PMID 18167382. http://jada.ada.org/cgi/pmidlookup?view=long&pmid=18167382. 
  29. "Bisphosphonate use and the risk of adverse jaw outcomes: a medical claims study of 714,217 people". J Am Dent Assoc 139 (1): 23–30. January 2008. doi:10.14219/jada.archive.2008.0016. PMID 18167381. http://jada.ada.org/cgi/pmidlookup?view=long&pmid=18167381. 
  30. "The importance of a thorough medical and pharmacological history before dental implant placement.". Aust Dent J 57 (3): 388–392. September 2012. doi:10.1111/j.1834-7819.2012.01717.x. PMID 22924366.  https://dx.doi.org/10.1111%2Fj.1834-7819.2012.01717.x
  31. Gaudin, Seidel, Bacevic, Rompen, Lambert, Elise, Laurence , Miljana , Eric, Lambert (October 2015). Occurrence and risk indicators of medication-related osteonecrosis of the jaw after dental extraction: a systematic review and meta-analysis. 
  32. G.Ghidini, M.Manfredi, I.Giovannacci, G.Mergoni, A.Sarraj, M.Mureddu, G.Giunta, M.Bonanini , M.Meleti, P. Vescovi (August 2017). Medication-related osteonecrosis of the jaw: risk factors in patients under biphosphonate versus patients under antiresorptive-antiangiogenic drugs.. 
  33. "Anti-resorptive Medical Definition". https://www.merriam-webster.com/medical/antiresorptive. Retrieved 19 February 2018. 
  34. Drake, Matthew T.; Clarke, Bart L.; Khosla, Sundeep (September 2008). "Bisphosphonates: Mechanism of Action and Role in Clinical Practice". Mayo Clinic Proceedings 83 (9): 1032–1045. doi:10.4065/83.9.1032. ISSN 0025-6196. PMID 18775204.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2667901
  35. Martin, T John (2000-06-01). "Experimental and Clinical Pharmacology: Bisphosphonates - mechanisms of action" (in en). Australian Prescriber 23 (6): 130–132. doi:10.18773/austprescr.2000.144. https://www.nps.org.au/australian-prescriber/magazine/23/6/130/2. 
  36. Michaelina Macluskey, Stephanie Sammut (March 2017). Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw Dental Clinical Guidance. SDCEP. pp. 4, 5. 
  37. Baron, Roland; Ferrari, Serge; Russell, R. Graham G. (2011). "Denosumab and bisphosphonates: Different mechanisms of action and effects". Bone 48 (4): 677–692. doi:10.1016/j.bone.2010.11.020. PMID 21145999. http://linkinghub.elsevier.com/retrieve/pii/S875632821002051X. 
  38. Samuel Durham, Rebecca Miller, Caryn Davis, Brian M (May 20, 2010). "Bisphosphonate Nephrotoxicity Risks and Use in CKD Patients". U.S. Pharmacist. 
  39. Dahiya, Navdeep; Khadka, Anjan; Sharma, A.K.; Gupta, A.K.; Singh, Nishith; Brashier, D.B.S. (January 2015). "Denosumab: A bone antiresorptive drug". Medical Journal, Armed Forces India 71 (1): 71–75. doi:10.1016/j.mjafi.2014.02.001. ISSN 0377-1237. PMID 25609868.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4297848
  40. McClung, Michael R. (2017). "Denosumab for the treatment of osteoporosis". Osteoporosis and Sarcopenia 3 (1): 8–17. doi:10.1016/j.afos.2017.01.002. http://linkinghub.elsevier.com/retrieve/pii/S2405525517300043. 
  41. "Angiogenesis Inhibitors" (in en). May 2018. https://www.cancer.gov/about-cancer/treatment/types/immunotherapy/angiogenesis-inhibitors-fact-sheet#q3. Retrieved 2018-02-19. 
  42. Rosella, Daniele; Papi, Piero; Giardino, Rita; Cicalini, Emauele; Piccoli, Luca; Pompa, Giorgio (2016). "Medication-related osteonecrosis of the jaw: Clinical and practical guidelines". Journal of International Society of Preventive & Community Dentistry 6 (2): 97–104. doi:10.4103/2231-0762.178742. ISSN 2231-0762. PMID 27114946.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4820581
  43. Al-Husein, Belal; Abdalla, Maha; Trepte, Morgan; Deremer, David L.; Somanath, Payaningal R. (December 2012). "Antiangiogenic therapy for cancer: an update". Pharmacotherapy 32 (12): 1095–1111. doi:10.1002/phar.1147. ISSN 1875-9114. PMID 23208836.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3555403
  44. Hao, Zhonglin; Sadek, Ibrahim (2016-09-08). "Sunitinib: the antiangiogenic effects and beyond". OncoTargets and Therapy 9: 5495–5505. doi:10.2147/OTT.S112242. ISSN 1178-6930. PMID 27660467.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5021055
  45. Beth-Tasdogan, N. H., Mayer, B., Hussein, H., & Zolk, O. (2017). "Interventions for managing medication-related osteonecrosis of the jaw". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.  https://dx.doi.org/10.1002%2F14651858
  46. Institute of Pharmacology of Natural Products & Clinical Pharmacology, Ulm University, Helmholtzstr. 20, Ulm, Germany, 89081.
  47. Effectiveness of treatments for medication-related osteonecrosis of the jaw: A systematic review and meta-analysis. El-Rabbany M, Sgro A, Lam DK, Shah PS, Azarpazhooh A. J Am Dent Assoc. 2017 Aug
  48. Lam, David K.; Sándor, George K. B.; Holmes, Howard I.; Evans, A. Wayne; Clokie, Cameron M. L. (June 2007). "A review of bisphosphonate-associated osteonecrosis of the jaws and its management". Journal of the Canadian Dental Association 73 (5): 417–422. ISSN 1488-2159. PMID 17555652.  http://www.worldcat.org/issn/1488-2159
  49. Management of Medication-related Osteonecrosis of the Jaw, An Issue of Oral and Maxillofacial Clinics of North America 27-4. 7 Jan 2016. Salvatore L. Ruggiero
  50. Medication-Related Osteonecrosis of the Jaws: Bisphosphonates, Denosumab, and New Agents 27 Nov 2014. Sven Otto
  51. Aliya A Khan; Archie Morrison; David A Hanley; Dieter Felsenberg; Laurie K McCauley; Felice O’Ryan; Ian R Reid; Salvatore L Ruggiero et al. (April 2014). "Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus". JBMR 30 (1): 3–23. doi:10.1002/jbmr.2405. PMID 25414052.  https://dx.doi.org/10.1002%2Fjbmr.2405
  52. Svejda, B.; Muschitz, Ch; Gruber, R.; Brandtner, Ch; Svejda, Ch; Gasser, R. W.; Santler, G.; Dimai, H. P. (1946). "[Position paper on medication-related osteonecrosis of the jaw (MRONJ)]". Wiener Medizinische Wochenschrift 166 (1–2): 68–74. doi:10.1007/s10354-016-0437-2. ISSN 1563-258X. PMID 26847441.  https://dx.doi.org/10.1007%2Fs10354-016-0437-2
  53. R. Fliefel; M. Tro¨ltzsch; J. Kühnisch; M. Ehrenfeld; S. Otto (May 2015). "Treatment strategies and outcomes of bisphosphonaterelated osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review". International Journal of Oral and Maxillofacial Surgery 44 (5): 568–85. doi:10.1016/j.ijom.2015.01.026. PMID 25726090.  https://dx.doi.org/10.1016%2Fj.ijom.2015.01.026
  54. Blus, Cornelio (23 August 2013). "Use of Ultrasonic Bone Surgery (Piezosurgery) to Surgically Treat Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ). A Case Series Report with at Least 1 Year of Follow-Up". The Open Dentistry Journal 7 (1): 94–101. doi:10.2174/1874210601307010094. PMID 24044030.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3772575
  55. Auto fluorescence image of post-radiation maxillary bone osteonecrosis in a 64-year-old patient – Case Report Aleksandra Szczepkowska1, Paweł Milner1, Anna Janas 1 Institute of Dental Surgery, Medical University, Łódź, Poland
  56. Comparison of auto-fluorescence and tetracycline fluorescence for guided bone surgery of medication-related osteonecrosis of the jaw: a randomized controlled feasibility study. Ristow O1, Otto S2, Geiß C3, Kehl V4, Berger M5, Troeltzsch M2, Koerdt S6, Hohlweg-Majert B7, Freudlsperger C5, Pautke C3.
More
Upload a video for this entry
Information
Subjects: Others
Contributor MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
View Times: 1.7K
Entry Collection: HandWiki
Revision: 1 time (View History)
Update Date: 19 Oct 2022
Notice
You are not a member of the advisory board for this topic. If you want to update advisory board member profile, please contact office@encyclopedia.pub.
OK
Confirm
Only members of the Encyclopedia advisory board for this topic are allowed to note entries. Would you like to become an advisory board member of the Encyclopedia?
Yes
No
${ textCharacter }/${ maxCharacter }
Submit
Cancel
There is no comment~
${ textCharacter }/${ maxCharacter }
Submit
Cancel
${ selectedItem.replyTextCharacter }/${ selectedItem.replyMaxCharacter }
Submit
Cancel
Confirm
Are you sure to Delete?
Yes No
Academic Video Service