Osteonecrosis of the jaw on antiresorptive therapy of osteoporosis: prevention, diagnosis, patient management.

Abstract

The analysis of contemporary publications devoted to the problem of medication-related osteonecrosis of the jaw (MRONJ) in patients receiving antiresorptive therapy is carried out. Since one of the most important risk factors for MRONJ is the dosage of the drug, this complication is much less common in patients with osteoporosis compared to cancer patients. The risk of MRONJ after tooth extraction when taking bisphosphonates for osteoporosis ranges from 0 to 0.15%, when taking denosumab — 1%. The basic rules for the management of a patient with osteoporosis receiving antiresorptive therapy in order to reduce the risk of developing MRONJ are formulated. These include consulting with a dentist before starting treatment for osteoporosis, especially in patients with high risk of MRONJ. It is necessary to maintain oral hygiene and perform invasive dental interventions before starting antiresorptive therapy. During the entire period of treatment of osteoporosis, it is necessary to pay attention to oral hygiene and timely conservative treatment of emerging problems. The patient should also be warned that when contacting the dentist, he should inform that he is receiving treatment for osteoporosis. A clinician engaged in the treatment of osteoporosis should know the signs of MRONJ and inform the patient about them. With the development of MRONJ, it is important to guide the patient with an informed dentist / maxillofacial surgeon. If an invasive dental intervention is necessary, the decision to discontinue treatment with bisphosphonates should be taken individually based on an analysis of the risk factors of the MRONJ and the severity of the intervention, and in the case of denosumab treatment, it should be carried out after 3–4 months after the last administration of denosumab. In some cases, it may be effective to add teriparatide to the combined therapy of MRONJ performed by a dentist / maxillofacial surgeon.