MRONJ (2022)

Question 1

What are some conditions (5) in which bisphosphonates are prescribed?

Answer 1

1. Hypocalcemia
2. Spinal cord compression/pathologic fractures related to bone metastases as seen commonly in breast, prostate, and lung cancers
3. Multiple myeloma
4. Osteoporosis/osteopenia
5. Metabolic bone disease such as Paget’s and osteogenesis imperfecta

Question 2

What are the 2 common oral BP’s?

What are the 2 common parenteral BP’s?

Answer 2

Oral:

1. Alendronate (Fosamax)
2. Residronate (Actonel)

Parenteral:

1. Zolendronic acid (Reclast/zometa)
2. Ibandronate (Boniva)

Question 3

What are the differences between Reclast and Zometa? (when are they used)
Both are…?

Answer 3

Both are Zolendronic Acid

Reclast is used for pt’s with high risk of bone fracture, Paget’s, osteoporosis

Zometa is used for high levels of blood calcium caused by cancer

Question 4

What is Denosumab?

2 common brand names?

How is it given and how often for each?

Answer 4

Denosumab is a monticlonal antibody…Rank-L inhibitor that prevents osteoclast function and associated bone resorption

Prolia and Xgeva

Prolia is given SubQ every 6 months
Xgeva is given SubQ every 4 weeks

prolia and xgeva are identical as far as the drug goes. The 2 names differentiate the dosing schedules

Question 5

What is Romosozumab?

Dosing schedule?

MOA?

Answer 5

A new monoclonal antibody used for fracture prevention in osteoporotic women

given subQ once a month for 12 months

Romosozumab works via the Wnt pathway by binding to and inhibiting sclerostin which leads to increase bone formation and decreased bone resorption

Question 6

What are the 3 elements of the case definition of MRONJ?

Answer 6

1. Current or previous tx with antiresorptive therapy
2. Exposed bone for more than 8 weeks
3. No history of radiation therapy to the jaws or mets to the jaws

Question 7

What are the key principles of stages 0-3 for MRONJ?

Answer 7

Stage 0:
NO exposed bone
Radiographic changes or dull aching may be present

Stage 1:
Exposed bone that is asymptomatic

Stage 2:
Exposed bone with evidence of infection/inflammation (symptomatic)

Stage 3:
Exposed bone with one or more of the following
-Exposed bone extending beyond the region of alveolar bone (inferior border/ramus of mandible, maxillary sinus and zygoma in the maxilla)
-pathologic fracture
-extraoral fistula
-oral antral/oral nasal communication
-osteolysis extending to the inferior border fo the mandible or sinus floor

Question 8

According to the update paper 2022, do BP’s have a higher chance of causing MRONJ than DMB?

Answer 8

No, they are relatively equivalent

Question 9

In simple terms, what is the MOA of MRONJ/

Answer 9

inhibition of osteoclasts from the drugs taken make it difficult for bone to heal

Question 10

According to the update paper 2022, animal studies evaluating withdrawal of BPs and DMB prior to tooth extraction showed what?

Answer 10

Discontinuing BPs had no effect on ONJ

Discontinuing DMB did successfully show prevention of MRONJ development in rats