A Comprehensive Analysis of Case Reports and Case Series on Medication-related Osteonecrosis of the Jaw

Mei Ling Chen^*
*Correspondence: Mei Ling Chen, Department of Dental Science, Chung-Ang University, Seoul, 06973, Republic of Korea, Email:

Introduction

Medication-Related Osteonecrosis Of The Jaw (MRONJ) is a significant clinical condition that has gained considerable attention in the medical and dental fields. This condition, characterized by exposed necrotic bone in the maxillofacial region persisting for more than eight weeks, primarily occurs in patients who have been treated with certain medications, particularly antiresorptive and antiangiogenic agents. The emergence of MRONJ has been closely linked to the use of bisphosphonates and denosumab, drugs commonly prescribed for osteoporosis, metastatic bone diseases, and certain cancers. Although these medications are effective in managing the underlying conditions, the unintended consequence of MRONJ has posed challenges in diagnosis, prevention, and treatment, leading to an increasing number of case reports and case series that aim to shed light on the phenomenon [1].

The examination of case reports and case series is essential in understanding the nuanced presentations, predisposing factors, and therapeutic outcomes of MRONJ. These publications offer detailed insights into individual patient experiences, often highlighting rare or atypical presentations that may not be captured in larger clinical trials. The value of such studies lies in their ability to inform clinical practice, guiding practitioners in identifying high-risk patients, implementing preventive measures, and selecting optimal therapeutic strategies. The pathogenesis of MRONJ is multifactorial, involving a complex interplay of drug effects, local trauma, infection, and patient-specific factors. Bisphosphonates, for instance, are known to inhibit osteoclast activity and bone remodeling, leading to prolonged bone retention [2].

Description

Case reports have frequently highlighted the role of dental procedures, such as tooth extractions, as common precipitating factors for MRONJ. In many instances, patients undergoing invasive dental treatments while on antiresorptive therapy experienced delayed healing, progressing to bone necrosis. The case series often underscore the importance of dental evaluations prior to initiating these therapies, emphasizing the need for proactive management of oral health to minimize risks. Additionally, these reports provide detailed accounts of clinical presentations, ranging from asymptomatic exposed bone to severe infections with pathological fractures, offering a comprehensive view of the condition's variability [3].

The role of systemic factors in predisposing patients to MRONJ is another area extensively explored in case reports and series. Conditions such as diabetes, rheumatoid arthritis, and malignancies, along with the use of corticosteroids or immunosuppressive agents, are frequently identified as contributing factors. Advanced age and poor nutritional status also emerge as recurring themes in these reports, underlining the importance of holistic patient assessment. Genetic predispositions, though less commonly addressed, have been implicated in a subset of cases, suggesting potential avenues for future research. Management strategies for MRONJ have evolved over time, largely informed by insights gleaned from case-based evidence. Conservative approaches, including antimicrobial therapy, pain management, and the use of antiseptic rinses, are often recommended for early-stage disease [4].

The psychosocial impact of MRONJ on patients is another dimension that case reports often bring to light. The condition not only affects physical health but also has profound implications for quality of life, self-esteem, and social interactions. Chronic pain, difficulty in eating and speaking, and the stigma associated with facial disfigurement are recurrent themes in patient narratives. By documenting these experiences, case reports serve as a reminder of the human aspect of the condition, urging healthcare providers to adopt a compassionate and patient-centered approach to care [5].

Conclusion

Despite the wealth of information provided by case reports and case series, several challenges and limitations exist. The retrospective nature of these studies often precludes definitive causal inferences, and the absence of standardized diagnostic criteria can lead to inconsistencies in reporting. Variability in treatment protocols and follow-up durations further complicates the interpretation of outcomes. Nonetheless, these limitations do not diminish the value of such studies; rather, they underscore the need for larger, prospective studies to validate and build upon their findings.

In conclusion, the comprehensive analysis of case reports and case series on MRONJ offers invaluable insights into the pathogenesis, clinical presentation, and management of this complex condition. These studies highlight the multifaceted nature of MRONJ, encompassing pharmacological, systemic, and procedural factors. While significant progress has been made in understanding and addressing the condition, ongoing research and collaboration across disciplines are essential to refine preventive strategies and therapeutic approaches. By learning from individual patient experiences, the medical and dental communities can continue to improve outcomes for those affected by MRONJ, ultimately enhancing both the science and the art of patient care.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Kumar, Mathangi, Ravindranath Vineetha and Adarsh Kudva. "Medication related osteonecrosis of jaw in a leukemia patient undergoing systemic arsenic trioxide therapy: A rare case report." Oral Oncol 99 (2019): 104343.

Google Scholar, Crossref, Indexed at

2. Khominsky, A. and M. A. W. T. Lim. "“Spontaneous” medication‐related osteonecrosis of the jaw; two case reports and a systematic review." Aus Dental J 63 (2018): 441-454.

Google Scholar, Crossref, Indexed at

3. Muthukrishnan, Arvind, Laliytha Bijai Kumar and Gomathi Ramalingam. "Medication-related osteonecrosis of the jaw: A dentist's nightmare." Case Rep 2016 (2016): bcr2016214626.

Google Scholar, Crossref, Indexed at

4. Chen, Yu-Feng and Hong-Po Chang. "Medication-related osteonecrosis of the jaw." New Eng J Med 388 (2023): e69.

Google Scholar, Crossref, Indexed at

5. Myoken, Yoshinari, Yoshinori Fujita, Ryota Imanaka and Shigeaki Toratani. "Bosutinib-induced osteonecrosis of the jaw in a patient with chronic myeloid leukemia: A case report." Oral Maxillofac Surg 2 (2021): 421-425.

Google Scholar, Crossref, Indexed at