2
Key Points
➤ Medication-related osteonecrosis of the jaw (MRONJ) is defined
as exposed bone or bone that can be probed through one or more
intraoral or extraoral fistulae in the maxillofacial region and that does
not heal within 8 weeks, occurring in a patient who has received a
bone-modifying agent (BMA) or an angiogenic inhibitor agent and has
no history of head and neck radiation.
➤ The condition may involve the mandible or the maxilla.
➤ BMAs that have been linked with MRONJ principally include
bisphosphonates and denosumab.
• BMAs are a key component of the management of patients with cancer with
skeletal metastases.
• These medications provide a number of clinical benefits, including a reduced
incidence of skeletal-related events (e.g., pathologic fractures and spinal cord
compression) and reduced need for radiation or surgery to bone.
• Use of BMAs is associated with MRONJ, which occurs in approximately 1–9%
of patients with advanced cancer.
➤ This pocket guide focuses on the prevention and management of
MRONJ in patients with cancer who receive BMAs for oncologic
indications.
➤ The pocket guide does not address BMAs used for osteoporosis,
which are administered at a lower dose and carry a lower risk
for MRONJ, nor does the pocket guide address the prevention or
management of MRONJ due to medications other than BMAs.
Diagnosis
➤ It is recommended that the term "medication-related osteonecrosis of
the jaw" (MRONJ) be used when referring to bone necrosis associated
with pharmacologic therapies. (Weak Recommendation; FC-Ins).
➤ Clinicians should confirm the presence of all three of the following
criteria in order to establish a diagnosis of MRONJ: 1) Current or
previous treatment with a BMA or angiogenic inhibitor, 2) Exposed
bone or bone that can be probed through an intraoral or extraoral
fistula in the maxillofacial region and that has persisted for longer
than 8 weeks, and 3) No history of radiation therapy to the jaws or
metastatic disease to the jaws. (Weak Recommendation; FC-Ins)
