Medication-Related Osteonecrosis in Cancer Patients
Summary
Medication-related osteonecrosis of the jaw is a serious complication arising in patients treated with high-dose antiresorptive and antiangiogenic therapies, notably bisphosphonates and denosumab, commonly prescribed to manage bone metastases in cancers such as breast, prostate and multiple myeloma. The condition is characterised by exposed necrotic bone in the maxillofacial region, often presenting with pain, swelling and secondary infection. Pathophysiology involves impaired osteoclast function and suppressed angiogenesis, leading to compromised bone remodelling and vascular supply. Key risk factors include invasive dental procedures, pre-existing oral infection, cumulative drug exposure and concurrent corticosteroid or chemotherapeutic regimens. Incidence varies with agent and duration of therapy but may exceed 2–3% in high-risk oncological cohorts. Global efforts focus on early dental evaluation, multidisciplinary care pathways and individualised risk assessment to prevent onset, while management strategies range from conservative antimicrobial therapy to surgical debridement or reconstruction, aiming to alleviate symptoms and restore function.
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Medication-Related Osteonecrosis in Cancer Patients publication trend
The graph below shows the total number of articles in medication-related osteonecrosis in cancer patients across all publications each year (not limited to Nature Index journals).
Technical terms
Medication-related osteonecrosis of the jaw (MRONJ): A condition of exposed necrotic jaw bone in patients receiving antiresorptive or antiangiogenic medications without prior radiotherapy.
Bisphosphonates: A class of antiresorptive agents that inhibit osteoclast-mediated bone resorption.
Denosumab: A monoclonal antibody against RANKL that reduces osteoclast formation and activity.
Antiangiogenic agents: Drugs that inhibit blood vessel formation, potentially compromising bone vascularity.
Osteoclast: A bone-resorbing cell essential for normal bone remodelling.
Sequestrum: A piece of dead bone separated from living bone during necrosis.
Autologous platelet concentrates: Preparations derived from the patient’s blood rich in platelets and growth factors promoting tissue repair.
Angiogenesis: The physiological process of new blood vessel formation.
References
- Autologous platelet concentrates as adjuvant in the surgical management of medication‐related osteonecrosis of the jaw. Periodontology 2000 (2024).
- Medication-related osteonecrosis of the jaws (MRONJ) in cancer patients treated with denosumab VS. zoledronic acid: A systematic review and meta-analysis. Medicina Oral Patología Oral y Cirugia Bucal (2020).
- Review and update on drugs related to the development of osteonecrosis of the jaw. Medicina Oral Patología Oral y Cirugia Bucal (2020).
- Osteonecrosis of the Jaw Associated with Antiangiogenics in Antiresorptive‐Naïve Patient: A Comprehensive Review of the Literature. BioMed Research International (2018).
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