Prevention of drug-induced osteonecrosis of the jaw in patients with osteoporosis: clinical recommendations

INTRODUCTION. Drug-induced osteonecrosis of the jaw (MRONJ) is one of the most severe complications of antiresorptive therapy in patients with osteoporosis, significantly impairing the quality of life. Despite the growing awareness of doctors, the frequency of MERS with prolonged use of bisphosphonates or denosumab remains in the range of 0.8–12.0%. The purpose of this work was to develop a comprehensive preventive strategy based on the analysis of risk factors aimed at reducing the incidence of MRONJ in patients with osteoporosis.

MATERIALS AND METHODS. A retrospective analysis of the medical records of 267 patients who received antiresorptive therapy at the Yizhida Dental Clinic in Shangqiu (China) from 2019 to 2023 was conducted. Dental status, biochemical markers of bone metabolism, treatment regimens, and concomitant risk factors were assessed. Various preventive approaches were compared. The results show that dental screening and oral sanitation before starting antiresorptive treatment reduces the risk of MERS by 72.6%.

RESULTS. Maintaining the level of β-CrossLaps above 150 pg/ml was associated with a 63.8% reduction in risk. Individualized surgical interventions, taking into account risk stratification, reduced the incidence of postoperative complications from 11.1% to 0% (with the combined protocol). The comprehensive preventive model provided a significant reduction in the 4-year cumulative incidence of MRONJ from 7.1% to 1.1%, while the effectiveness of the main antiresorptive therapy was not affected.

CONCLUSIONS. The analysis makes it possible to recommend a multi-level prevention system, including dental screening, biomarker monitoring, and surgical tactics adapted to individual risk, as an effective strategy for preventing MERS in patients with osteoporosis.

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