MRONJ

Question 1

What is MRONJ

Answer 1

exposed bone in the maxilla or mandible that has persisted for more than 8 weeks in patients takeing anti-resorptive or anti-angiogenic drugs and where there is no history of radiation or no obvious metastatic disease of the jaws

Question 2

symptoms of MRONJ

Answer 2

• delayed healing after extraction or other trauma
• sometimes spontanous without obvious trauma
• pain
• soft tissue infection and swelling
  -numbness
• exposed bone - sometimes absent

Question 3

incidence of MRONJ

Answer 3

• Cancer patients treated with anti-
  resorptive or anti-angiogenic drugs 1% (1
  case per 100)
• Osteoporosis patients treated with anti-
  resorptive drugs 0.01-0.1% (1-10 cases per
  10,000)

Question 4

risk factors for MRONJ

Answer 4

 Underlying medical condition
 Cumulative drug dose
 Concurrent treatment with steroids
 Surgery/trauma

Question 5

Drugs that can cause MRONJ

Answer 5

 Bisphosphonates
 RANKL inhibitors
 Anti-angiogenic drugs

Question 6

what are bisphosphonates

Answer 6

Drugs that reduce bone resorption by
hindering the formation, recruitment and
function of osteoclasts
commonly used for osteoporosis

Question 7

examples of oral form of bisphosphonates

Answer 7

alendronic acid
risedronate sodium

Question 8

what are RANKL inhibitors

Answer 8

 Anti-resorptive drugs
 Inhibits osteoclast function and bone
resorption
 Reduce risk of # and chronic pain in
osteoporosis
 Also used in cancer

Question 9

give an example of a RANKL inhibitor

Answer 9

denosumab

Given 6 monthly for osteoporosis
 Given every month for cancer
 Effects diminish within 9 months of
treatment completion

Question 10

what are anti-angiogenic drugs

Answer 10

 Treatment of cancer
 Restrict the growth of tumour blood
vessels
 Lenalidomide
 Aflibercept
 Sunitinib