Current Opinion on MRONJ

Patients on antiresorptive medication have been increasing since the introduction of the bisphosphonates as an effective agent. As an antiresorptive agent bisphosphonate has substantial effect in treatment of osteoporosis, and its antiangiogenic potential renders it a powerful anticancer effect. With all the fantastic effect, it has a critical result of jaw bone necrosis, namely bisphosphonate-related osteonecrosis of the jaw (BRONJ). Although extremely rare [1,2], the number of cases reporting this phenomenon is growing worldwide [3-8]. The special committee dealing with the problem of osteonecrosis found on the jaw bones of patients on bisphosphonate recommends changing the nomenclature BRONJ for medication-related osteonecrosis of the jaw (MRONJ) [9]. It is based on the new findings of jaw bone necrosis related to other types of antiresorptive drugs including Denosumab (Prolia®), a monoclonal antibody to RANK ligand, and other antiangiogenic agents such as Becacizumab (Avastin®). Established as a clinically significant disease entity, investigation of MRONJ needs further considerations into the risk factors and drug holiday as a means of prognostic improvement.