MRONJ- HURST & COLLEYVILLE, TX

Medication-related osteonecrosis of the jaws ( MRONJ) or osteonecrosis is a well-known side effect of bisphosphonates and other medications that may be used to treat osteoporosis or cancer. These medications may result in exposed, painful bone, usually following a dental procedure such as a tooth extraction. 

Although these medications may be excellent at managing osteoporosis or cancer, one side effect that may occur is osteonecrosis. Osteonecrosis means “dead bone”. Whenever a tooth is extracted, dental surgery is performed, or trauma is sustained when eating or brushing, your body starts a response to heal the bone and soft tissue in your mouth. These medications interrupt that normal healing process, resulting in dead bone. A procedure to remove the dead bone may be required to eliminate the pain and symptoms involved in osteonecrosis.

Patients who are at risk may have taken the following medications:

1. Bisphosphonates – used for cancer related bone disease, Osteoporosis, Multiple myeloma etc.

1. Intravenous (IV) bisphosphonates – Highest risk

• Zoledronic acid (Zometa, Reclast)
• Pamidronate (Aredia)

1. Oral bisphosphonates – Lower risk

• Alendronate (Fosamax)
• Risedronate (Actonel)
• Ibandronate (Boniva)

2. RANKL Inhibitors : used for cancer or osteoporosis

• Denosumab (Prolia, Xgeva)
• Xgeva (for cancer): higher MRONJ risk
• Prolia (for osteoporosis): lower risk

3. Antiangiogenic Agents : used in treatment of cancer ( eg Renal cell carcinoma, colorectal cancer etc)

• Bevacizumab (Avastin)
• Sunitinib (Sutent)
• Sorafenib (Nexavar)
• Axitinib (Inlyta)

Less Common Medications Also Implicated

• mTOR inhibitors (e.g., Everolimus)
• Tyrosine kinase inhibitors (e.g., Imatinib)
• Immune checkpoint inhibitors 

Patients who have had any of these medications in IV form for cancer therapy have approximately a 12% risk of developing osteonecrosis following an incident such as a tooth extraction. Patients who had taken IV forms of these medications for osteoporosis have approximately a 1% change of developing osteonecrosis. Patients who have taken oral forms of these medications for osteoporosis have approximately a 0.1% change of developing osteonecrosis. 

For patients who have taken these medications, have had dental surgery, and now notice exposed bone in your mouth, you may have osteonecrosis. Osteonecrosis may cause the following symptoms: 

• Exposed bone in the mouth 
• Jaw pain
• Swelling or drainage
• A bad smell
• Changes in your bite

Depending on the severity of osteonecrosis, a variety of treatment options are available to treat the exposed bone and pain associated with osteonecrosis.