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Semin Musculoskelet Radiol 2016; 20(03): 305-314
DOI: 10.1055/s-0036-1592367
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bisphosphonate and Medication-Related Osteonecrosis of the Jaw: A Review

Thomas Mücke
1   Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
,
Christian R. Krestan
2   Department of Biomedical Imaging und Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
,
David A. Mitchell
1   Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
,
Jan S. Kirschke
3   Department of Radiology, Technische Universität München, Klinikum Rechts der Isar, Germany
,
Arno Wutzl
4   Trauma Hospitals AUVA LBK und UKH Meidling, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
14 October 2016 (online)

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Abstract

For patients with malignant disease taking bisphosphonates and denosumab, the incidence of medication-related osteonecrosis of the jaw (MRONJ) is up to 15% in contrast to 0.01% in patients with osteoporosis. Clinical presentation of MRONJ extends from asymptomatic exposure of bone in 94% of patients to severe cases of mandibular fractures in a minority of 4.5%. The strongest risk factors for MRONJ are invasive dental procedures and dental infections. Advances in imaging provide more preoperation information compared with panoramic radiograph. Prevention strategies are the elimination of potential risk factors leading to invasive dental procedures and maintenance of good oral hygiene prior to the administration of antiresorptive agents. Management of MRONJ depends on the underlying disease, extent of the necrosis, and the presence of contributing therapy. Conservative therapies include topical anti-infective rinses and systemic antibiotic therapy. The most important part of surgical therapy is to remove the exposed and necrotic bone. Several options for defect closure are possible from local tissue flaps to microvascular free flap procedures. The development of MRONJ in conjunction with dental implants is a severe side effect and should be avoided if potentially harmful medication has already been administered.

Keywords

osteonecrosis of the jaw - bisphosphonates - denosumab - osteoporosis - computed tomography - magnetic resonance imaging - dental radiographs
 

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