Study on Hyperglycemia and Medication-Related Osteonecrosis of the Jaw (MRONJ)

A new study by Gabor Kammerhofer and team showed that ischemia is a consequence of high glucose levels and may be a risk factor for the development of necrosis. The findings of this study were published in the Journal of Clinical Medicine.

Medication-related osteonecrosis of the jaw (MRONJ) is a kind of jawbone necrosis induced by the use of cancer and osteoporosis medications. Bisphosphonates and Denosumab injection are the two primary components of antiresorptive treatment. By blocking the farnesyl pyrophosphate synthase enzyme, currently utilized aminobisphosphonates can be liberated from bone destroyed by osteoclasts and cause cellular death. The purpose of this study was to look at the links between hyperglycemia and the development of medication-related osteonecrosis of the jaw.

The study looked at data collected between January 1, 2019 and December 31, 2020. A total of 260 patients were chosen from Semmelweis University's Inpatient Care Unit, Department of Oromaxillofacial Surgery and Stomatology. The study made use of and included fasting glucose data.

Key Findings

• Hyperglycemia was found in approximately 40% of the necrosis group and 21% of the control group.
• Hyperglycemia and MRONJ had a significant correlation (p < 0.05, p = 0.003).
• Hyperglycemia-induced vascular abnormalities and immunological dysfunction can result in necrosis following tooth extraction.
• The mandible (75.0%) and parenteral antiresorptive therapy (intravenous Zoledronate and subcutaneous Denosumab) are more prone to necrosis.
• Hyperglycemia is a more significant risk factor than poor dental hygiene (26.7%).

The findings of this study reveal that the probability of developing MRONJ in patients with dysglycemia is statistically considerably higher than in those with normoglycemia. This study assesses the characteristics (e.g., age, gender, type of cancer, presence of osteoporosis) and behaviors (such as smoking and drinking alcohol) of patients, as well as the potential combined effects of dysglycemia and antiresorptive medication that may result in ischemia. Based on the findings, ischemia may be a risk factor for developing jawbone necrosis following invasive dental or oral surgical treatments, particularly in the lower jaw.

Reference

Kammerhofer, G., Vegh, D., Bányai, D., Végh, Á., Joob-Fancsaly, A., Hermann, P., Geczi, Z., Hegedus, T., Somogyi, K. S., Bencze, B., Biczó, Z., Juhász, D. H., Zaborszky, P., Ujpál, M., Vaszilkó, M. T., & Németh, Z. (2023). Association between Hyperglycemia and Medication-Related Osteonecrosis of the Jaw (MRONJ). In Journal of Clinical Medicine (Vol. 12, Issue 8, p. 2976). MDPI AG. https://doi.org/10.3390/jcm12082976