SDCEP Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw Flashcards
What is MRONJ?
Side effect of anti-resorptive & anti-angiogenic drugs
- exposed bone in the maxillofacial region that has persisted for more than 8 weeks
- in pts with history of treatment with these drugs & no history of radiation therapy to the jaws
What are some signs & symptoms of MRONJ?
- delayed healing
- pain
- soft tissue infection & swelling
- numbness
- paraesthesia
- exposed bone
What cancers should be warning signs for potential development of MRONJ after dental extractions?
- breast cancer
- prostate cancer
- multiple myeloma
Who is more at risk of developing MRONJ, cancer patients or osteoporosis patients?
Cancer pts
What are anti-resorptive drugs & how do they work?
Anti-resorptive drugs inhibit osteoclast differentiation and function, leading to decreased bone resorption & remodelling
What are the two main types of anti-resorptive drugs that have been associated with MRONJ?
bisphosphonates & denosumab
What is the half-life of alendroate in bone?
10 years
What are anti-angiogenic drugs & how do they work?
Target the processes by which new blood vessels are formed & used to restrict tumour vascularisation
What are some risk factors for development of MRONJ?
- tooth extractions
- previous episode of MRONJ
- duration of bisphosphonate therapy
- anti-resorptive drugs + chronic system glucocorticoid taken together
- dental trauma
What risk status would a patient be at for MRONJ if they are being treated for osteoporosis with oral bisphosphonates for <5 years & not taking systemic glucocorticoids?
LOW RISK
What risk status would a patient be at for MRONJ if they are being treated for osteoporosis with quarterly/yearly IV bisphosphonates for <5 years & not taking systemic glucocorticoids?
LOW RISK
What risk status would a patient be at for MRONJ if they are being treated for osteoporosis with denosumab & not taking systemic glucocorticoids?
LOW RISK
What risk status would a patient be at for MRONJ if they are being treated for osteoporosis with oral/IV bisphosphonates for >5 years?
HIGH RISK
What risk status would a patient be at for MRONJ if they are being treated for osteoporosis with oral bisphosphonates or denosumab & taking systemic glucocorticoids concurrently?
HIGH RISK
What risk status would a patient be at for MRONJ if they are being treated for cancer with anti-resorptives or anti-angiogenic drugs?
HIGH RISK
