Medication-Related Osteonecrosis of the Jaw: Contemporary Concepts and Clinical Decision-Making

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) is increasingly encountered due to the widespread use of antiresorptive and antiangiogenic therapies. Despite extensive research, consensus on optimal prevention and management remains incomplete.

Objectives: To critically appraise and synthesize current evidence on MRONJ and present a systematic-style narrative review emphasizing clinically relevant decision-making.

Methods: A structured literature search of major biomedical databases was undertaken, focusing on publications addressing MRONJ definition, epidemiology, pathogenesis, prevention, and management. Evidence from systematic reviews, cohort studies, clinical trials, and consensus guidelines was narratively synthesized.

Results: MRONJ incidence is low in osteoporosis patients but substantially higher in oncology populations receiving high-dose therapy. Suppressed bone remodeling, local infection, and jaw-specific anatomical factors underpin disease pathogenesis. Preventive dental care significantly reduces risk. Evidence increasingly supports early surgical intervention across disease stages, while the benefit of prophylactic and therapeutic drug holidays remains uncertain and drug-specific.

Conclusions: MRONJ management should prioritize prevention, early diagnosis, and individualized treatment strategies. Surgical management offers superior long-term outcomes in appropriately selected patients. Further prospective research is required to refine risk prediction and optimize long-term management.