Medication-Related Osteonecrosis of the Jaw
Key Points
Key Points
- Medication-related osteonecrosis of the jaw (MRONJ) is defined as exposed bone or bone that can be probed through one or more intraoral or extraoral 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 has 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.
- These medications provide a number of clinical benefits, including a reduced incidence of skeletal-related events (e.g., pathologic fractures and spinal cord compression) and reduced need for radiation or surgery to bone.
- Use of BMAs is associated with MRONJ, which occurs in approximately 1–9% of patients with advanced cancer.
- This pocket guide focuses on the prevention and management of MRONJ in patients with cancer who receive BMAs for oncologic indications.
- The pocket guide does not address BMAs used for osteoporosis, which are administered at a lower dose and carry a lower risk for MRONJ, nor does the pocket guide address the prevention or management of MRONJ due to medications other than BMAs.
Diagnosis
Diagnosis
...ecommended that the term “medicatio...
...linicians should confirm the presence of all thr...
Risk Reduction
...Reduction...
...ion of CareFor cancer patients scheduled to...
...FactorsMembers of the multidisciplinary team sho...
...Dentoalveolar SurgeryElective dentoalv...
...alveolar Surgery Follow-UpIf dentoalv...
...ry Discontinuation of BMAs Prior to Dentoalveo...
Staging
Staging
...ell-established staging system should be used...
...ly, staging should be performed by a clinici...
Treatment
...eatment
...nt of MRONJConservative measures compris...
...f Refractory MRONJAggressive surgi...
...orary Discontinuation of BMAsFor patients diagn...
...uresDuring the course of MRONJ treatment, the de...
...nd Risk of MRONJHaving trouble viewing table? Ex...
...posed Terms to Characterize ONJ After Trea...
...scriptions of Complete, Partial and Minimal Den...
.... MASCC/ISOO Daily Oral Care Plan for PatientsH...
...e 5. Treatment Strategies by Stage o...
...nagement Flow Diagram...
...Consider continuation...