013: MRONJ Review

MRONJ Review: What You Need to Know

Today I want to dive into the important topic of medication-related osteonecrosis of the jaw, or MRONJ. We used to call this "BRONJ" for bisphosphonate-related osteonecrosis of the jaw, but now we know other medications can also cause this serious complication.

Common culprits I see in my practice:
- Bisphosphonates: Fosamax, Boniva, Actonel, Reclast, Zometa (IV forms like Reclast and Zometa carry higher risk than oral)
- RANKL inhibitors: Prolia, Xgeva

When patients on these meds need extractions or other oral surgery, we take extra precautions:
- Consult with prescribing physician
- For IV drugs, wait as long as feasible after last dose
- For oral, consider 3-month drug holiday (though this is controversial)
- Unfortunately, no reliable pre-op tests to predict individual risk

MRONJ staging and management:
- At-risk: Not yet affected. Focus on prevention, education, and optimizing oral health before starting meds.
- Stage 0: Non-specific symptoms without exposed bone. Conservative care.
- Stage 1: Exposed/necrotic bone, no infection. Rinses, hygiene, avoid further surgery.
- Stage 2: Exposed bone with infection, pain, swelling, pus. Add antibiotics, limited surgical debridement.
- Stage 3: Extensive necrosis, severe pain, pathologic fracture, extraoral fistula. Aggressive resection may be needed.

I have high-risk patients sign a special MRONJ consent so expectations are clear. Extra red flag if they also take steroids!

Feel free to reach out for a copy of our consent form or with any other questions at [email protected]. Talk to you next week!