Medication related osteonecrosis of the jaw (MRONJ) in Universiti Kebangsaan Malaysia Medical Centre: prevalence relevant factors, prevention and treatment

Abstract

Medication-related osteonecrosis of the jaw bones (MRONJ) is a well-known complication of drugs of concern. There are three main groups of medications linked to the MRONJ: antiresorptive drugs, antiangiogenic drugs, and RANKL inhibitors. MRONJ could occur spontaneously or as a result of dental trauma, following drug administration. The diagnosis depends on the clinical examination and imaging such as the orthopantomogram and computer tomography. This retrospective record review was conducted from February 2018 to May 2022 in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This study was conducted to determine the association between the patient, drug and dental-related factors with MRONJ. 75 medical records of patients who fulfil the inclusion criteria were selected. Demographic, clinical data and radiographic findings were collected. There were 28 (37.3%) men and 47 (62.7%) women with a median age of 67.85 ± 11.05 years (range 21-89 years). The majority of patients were Malays (n=50, 66.7%), followed by Chinese (n=20, 26.7%), and Indians (n=5, 6.7%). Of the 75 patients, 11 (5.5%) patients were confirmed with MRONJ. Of the 11 patients, 3 (27.2%) patients had MRONJ spontaneously while the other 8 (72.8%), following dental trauma. A statistically significant association was found between the duration of drug use (more than 24 months versus less than 24 months) and the development of MRONJ. In addition, the association between comprehensive dental care (CDC) before and during the treatment and MRONJ showed statistically significant results. These two factors were included in the binary logistic regression and the CDC remained as a statistically significant factor for MRONJ. The findings from this research confirms the importance of dental treatment before commencing the treatment with the drugs of concern. In conclusion, MRONJ is commonly detected clinically following 24 months after commencing the treatment and CDC is an effective preventive measure.