5
Table 1. BMAs and Risk of MRONJ
Medication Indication Route Dose Schedule
Frequency
of MRONJ
a
Pamidronate Bone metastases of
solid tumors
Multiple myeloma
IV 90 mg Every 3–4
weeks
3.2–5.0%
Zoledronic
acid
Bone metastases of
solid tumors
Multiple myeloma
IV 4 mg Every 3–4
weeks or 12
weeks
1.0–8.0%
Adjuvant treatment IV 4 mg Every 3–6
months
0–1.8%
Denosumab Bone metastases of
solid tumors
SC 120 mg Every 4
weeks
0.7–6.9%
b
Adjuvant treatment SC 60 mg Every 6
months
0%
a
e risk of MRONJ varies by duration of treatment.
b
e estimate of 6.9% is from the open label extension phase of two phase 3 studies. It is not adjusted
for patient-years of exposure or patient follow-up and does not include cases that occurred during
the blinded treatment phase. e patient-year adjusted incidence of confirmed ONJ was 1.1%
during the first year of denosumab treatment, 3.7% in the second year, and 4.6% per year thereaer.
Outcome Measures
➤ During the course of MRONJ treatment, the dentist/dental specialist
should communicate with the medical oncologist the objective
and subjective status of the lesion – resolved, improving, stable
or progressive. The clinical course of MRONJ may impact local
and/or systemic treatment decisions with respect to cessation or
recommencement of BMAs. (Weak Recommendation; FC-Ins)
Treatment
