Study on MRONJ and Angiogenic Inhibitors

Patients who are taking multiple doses of angiogenic inhibitors should be monitored closely for early diagnosis of possible medication-related osteonecrosis of the jaw (MRONJ), according to a recent study published in The Journal of the American Dental Association.

The aim of this review was to discuss the current and newly emerging antiresorptive medications and their potential implications for dental surgeries.

Methodology

The authors searched PubMed (MEDLINE), Cochrane, Embase, and other electronic databases for articles related to osteonecrosis of the jaw and medication-related osteonecrosis of the jaw (MRONJ). In addition, the authors hand searched the bibliographies of all relevant articles, the gray literature, textbooks, and guidelines in association position statements.

Results

• Metastatic carcinoma has a higher risk than osteoporosis.
• Parenterally administered bisphosphonates and denosumab have a higher risk than orally administered bisphosphonates or antiangiogenic agents.
• Consideration of dose and duration of medication received.
• Adjunctive medications or combination of antiresorptive agents may increase the risk of MRONJ.
• Additive factors and comorbidities such as diabetes, autoimmune disease, immunosuppression, or any condition that might affect healing negatively would result in potentially higher risk of developing MRONJ.
• Angiogenic inhibitors as part of a cancer treatment regimen, with or without antiresorptive medication, are considered high risk.

Thus, patients who received antiresorptive therapy for malignancy were at higher risk of developing MRONJ than those who received the therapy for osteoporosis, regardless of the route of administration and type of drug. Antiangiogenic agents, bevacizumab, aflibercept, and tyrosine kinase inhibitors such as sunitinib were implicated most commonly in the development of MRONJ. Patients who are taking multiple doses of angiogenic inhibitors should be monitored closely for early diagnosis of possible MRONJ.

Reference

Emerging antiresorptive medications and their potential implications for dental surgeries by Anita Aminoshariae et al. published in The Journal of the American Dental Association.

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