Medication Related Osteonecrosis of the Jaws

Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse drug reaction, including of bone destruction in the jaws. Osteonecrosis of the jaws can be caused by two pharmacological agents: antiresorptive (including bisphosphonates (BPs) and receptor activator of nuclear factor kappa-B ligand [RANK-L] inhibitors) and antiangiogenic. Among the drugs associated with the development of MRONJ, BPs are the most widely used for a wide variety of clinical indications. Bisphosphonates are used in bone metabolism-related diseases such as Paget’s disease, fibrous dysplasia, osteogenesis imperfecta, but mainly in lung, prostate, breast carcinomas, multiple myeloma and osteoporosis. The effect of the drug depends on the dose and duration of administration. Epidemiological studies showed that long-term use of these drugs may increase the risk of MRONJ development. The purpose of this review is to define the current information about MRONJ, the management strategies and preventive measures.