not take the medication. One study showed that patients that take injectable antiresorptive medications, have a 2.3% risk of developing MRONJ, which is 7.7 times higher than the MRONJ risk of oral bisphosphonates.1 The reason why a patient requires antiresorptive medication can also impact their level of risk. Patients taking antiresorptive medication for bone cancer are at a higher risk than those who taking it for osteoporosis, because patients with bone cancer need a higher dose of the medication.2 Among this patient population, the risk of MRONJ after an extraction is 1.6% to 14.8%.2 Common Antiresorptive Medications Bisphosphonates • alendronate (Fosamax)—Taken orally • etidronate (Didrocal)—Taken orally • risedronate (Actonel)—Taken orally • zoledronic acid (Aclasta)—Tablet taken orally • Fosavance (Fosamax with vitamin D)—Tablet taken orally • clodronate (Bonefos)—Orally or intravenously • pamidronate (Aredia)—Given intravenously • zoledronic acid (Zometa)—Given intravenously Monoclonal Antibodies • denosumab (Prolia)—Given subcutaneously every 6 months Scerlostin Inhibitor • romosozumab (Evenity)—Given subcutaneously once a month What is MRONJ? Medication-related osteonecrosis of the jaw (MRONJ) can be diagnosed when all of the following conditions are met: a) Exposed bone in the jaw that has lasted for more than 8 weeks b) Current or past use of antiresorptive medications c) No history of radiation therapy or bone metastasis to the jaws What are the highest risk factors of MRONJ? The following increase the risk factors for MRONJ: • Patient is taking antiresorptives by injection • Patient is taking antiresorptives due to bone cancer • Dentoalveolar surgery • The operative site is the posterior mandible What decreases the risk of MRONJ? Avoiding dentoalveolar surgery, performing surgical procedures prior to beginning antiresorptive therapy, good oral hygiene, regular hygiene visits, ensuring intraoral appliances are well fitted, managing co-morbidities and inflammation, and smoking cessation decrease the risk of MRONJ. Does suspending antiresoprtive therapy decrease the risk of MRONJ? There is no consensus on the benefits of a temporary suspension of antiresorptive therapy because there is inconclusive evidence that it decreases the risk of MRONJ.3 Antiresorptives continue to affect the bone after patients stop taking the medication. If dentoalveolar surgery is necessary and there is a high risk of MRONJ, you may consider asking the medical professional who prescribed the antiresorptive therapy to advise the patient to suspend taking the medication. Because there is no standard, medical professionals may have different opinions after weighing the benefits and risks. Dentists cannot advise patients to discontinue antiresorptive therapy. 39 Issue 5 | 2024 | SupportingYour Practice
RkJQdWJsaXNoZXIy OTE5MTI=