Medication related osteonecrosis of the jaw unrelated to bisphosphonates and denosumab- a review

Publication date: Available online 3 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Rebecca King, Nikki Tanna, Vinod Patel

Abstract

The link between medication related osteonecrosis of the jaw (MRONJ) and bone modulating therapies such as bisphosphonates and denosumab is well established and the number of reported cases is increasing. The development of novel medications in cancer therapy, autoimmune and bone conditions has led to further cases of MRONJ being reported. However, in addition to this group of medications there are increasingly new agents in cancer therapy, such as anti-angiogenics agents that have now also been implicated in the development of MRONJ. As these newer agents with similar mechanisms are routinely used, the numbers of reported cases will likely rise further.

This paper aims to identify and summarise the drugs indicated in MRONJ aside from bisphosphonates and denosumab. A wide range of medications classed as tyrosine kinase inhibitors, monoclonal antibodies, mammalian target of rapamycin inhibitors, radiopharmaceuticals, selective estrogen receptor modulators and immunosuppresants have been implicated in MRONJ.

It remains crucial that oral health care providers are aware of these new medications and their associated risks in order to manage patients appropriately.

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