MRONJ Flashcards
What is MRONJ?
Medication related osteonecrosis of the jaw
- exposed bone that isn’t healing
What drugs is MRONJ a side effect of?
Anti-resorptive drugs
- bisphosphonates
Anti-angiotensin drugs
What are the signs and symptoms of MRONJ?
- delayed healing following dental extraction/oral surgery
- pain
- soft tissue infection & swelling
- numbness
- parasthesia
- exposed bone
Why does MRONJ happen?
- suppressed bone turnover
- inhibition of angiogenesis
- toxic effects on soft tissue
- inflammation or infection
In which hospital patients is MRONJ more likely to occur after oral surgery?
Cancer patients
- drugs for management of solid tumours (e.g breast/prostate cancer) typically on anti-resorptive or anti-angiogenic drugs
What are anti-resorptive drugs & how do they work?
Anti-resorption drugs inhibit osteoclast differentiation & function
- leads to decreased bone resorption & remodelling
What types of anti-resorptive drugs are associated with development of MRONJ?
- bisphosphonates
- denosumab
How do bisphosphonates work?
Reduced bone resorption by inhibiting enzymes essential to the formation, recruitment & function of osteoclasts
How does denosumab work?
Denosumab is a monoclonal antibody which inhibits osteoclast function and associated bone resorption by binding to the receptor activator nuclear factor KB ligand (RANKL)
What are anti-angiogenic drugs and how do they work?
They target the processes by which new blood vessels are formed and are used in cancer treatment to restrict tumour vascularisation
What anti-angiogenic drugs are associated with development of MRONJ post oral-surgery?
- bevacizumab
- aflibercept
- sunitinb
What are risk factors for MRONJ?
- underlying medical condition for which patient is being treated (eg cancer patients)
- previous MRONJ diagnosis
- dental treatment
- duration of bisphosphonate drug therapy
- other concurrent medications
- dental implants
What other medications (aside from bisphosphonates) can increase a patients risk of developing MRONJ?
Chronic systemic glucocorticoid
What would place a patient in the low-risk category of development of MRONJ?
- patients using oral/IV bisphosphonates (for osteoporosis) for less than 5 years that are not using systemic glucocortoids
- patients using denosumab for osteoporosis for less than 5 years that are not using systemic glucocortoids
What would place a patient in the high-risk category of development of MRONJ?
- patients using bisphosphonates for osteoporosis for more than 5 years
- patients using bisphosphonates and systemic glucocortoids concurrently for any length of time (for osteoporosis)
- patients using anti-absorptives or anti-angiogenics for treatment of cancer
- patients with previous diagnosis of MRONJ
