The role of antiresorptive drugs and medication related osteonecrosis of the jaw in non-oncologic immunosuppressed patients: a systematic review

Research output: Contribution to journalArticlepeer-review

  • External authors:
  • Roberto Sacco
  • Julian Woolley
  • Monica Calasans
  • Oladapo Akintola
  • Vinod Patel


Background: Medication related osteonecrosis of the jaw (MRONJ) is a severe condition affecting the jaws of patients exposed to specific drugs including bisphosphonates, RANK ligand inhibitors (denosumab) and antiangiogenic drugs. It has been proposed that the existence of other concomitant medical conditions may increase the incidence of MRONJ. The primary aim of this systematic review was to analyze all available evidence and evaluate the reported outcomes of osteonecrosis of the jaws (ONJ) due to antiresorptive drugs in immunosuppressed patients. Material and methods: PubMed, MEDLINE, EMBASE and CINAHL databases were searched to identify related English and non-English papers published from January 2003 until April 2020. Data was extracted from relevant papers and results summarised. Results: The search generated twenty seven studies eligible for the analysis. The total number of patients included in the analysis was two hundred and six. All patients were deemed to have some form of immunosuppression, with some patients having more than one disorder contributing to their immunosuppression. Clear trends in MRONJ aetiology; presentation and diagnostic features were found within the results. MRONJ complications and recurrence after treatment was sparsely reported in the literature, however a total of fourteen cases were observed. Conclusions: The data reviewed have confirmed that an invasive procedure is the commonest trigger of MRONJ with relatively high frequency of post-operative complications or recurrence following management. However, due to low-quality research available in the literature it is difficult to draw a definitive conclusion on the outcomes analysed in this systematic review.

Bibliographical metadata

Original languageEnglish
JournalJournal of Research in Medical Sciences
Issue number23
Publication statusPublished - 31 Mar 2021