Radiographic Analysis of MRONJ in Osteoporotic and Oncologic Patients on Bisphosphonates or Denosumab.

INTRODUCTION

Medication-Related Osteonecrosis of the Jaw (MRONJ) is a severe adverse effect of antiresorptive and antiangiogenic treatment, primarily in osteoporotic and oncologic patients. The disease is characterized by persistent jawbone necrosis that results in significant impairment of the quality of life of involved patients. The aim of this study is to compare the radiographic characteristics of MRONJ between osteoporotic and oncologic patients and assess the differences based on treatment type, particularly bisphosphonates and denosumab (RANK-L inhibitors).

METHODS

A retrospective analysis of 152 MRONJ patients (41 osteoporotic, 111 oncologic) from Rabin-Bilinson Medical Center (2014-2024) examined radiographic features-lytic changes, sclerosis, periosteal reactions, sequestration, and periodontal ligament destruction-using panoramic radiography, CBCT, and MDCT.

RESULTS

Sclerosis was more frequent in osteoporotic patients compared to oncologic patients (p < 0.05). No statistically significant differences were found in other radiographic features. Bisphosphonate-induced MRONJ was more frequently accompanied by sclerosis compared to denosumab-related cases in osteoporotic patients (p = 0.0318), while no significant differences were found in the oncologic group.

CONCLUSIONS

Most of the radiographic features of MRONJ were similar in osteoporotic and oncologic patients. However, sclerosis was more common in osteoporotic patients exposed to Bisphosphonates, which may be due to their prolonged exposure to antiresorptive drugs.