Medication-related osteonecrosis of the jaw in osteoporotic patients receiving antiresorptive therapy: prevalence and associated risk factors.

UNLABELLED: Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon complication of antiresorptive therapy in osteoporosis. In this real-world cohort, longer treatment duration and tooth extraction were associated with MRONJ. These findings may improve risk assessment and support preventive dental management in high-risk patients.

OBJECTIVE

Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon but clinically important complication of antiresorptive therapy in osteoporosis. This study investigated the prevalence of MRONJ and factors associated with its development in osteoporotic patients receiving antiresorptive treatment.

METHODS

This retrospective cohort study included patients with osteoporosis treated with antiresorptive agents between January 2020 and December 2025. Of 2153 screened records, 1131 met the inclusion criteria. Demographic, clinical, treatment-related, and oral-dental characteristics were collected. MRONJ was diagnosed and staged according to the 2022 American Association of Oral and Maxillofacial Surgeons (AAOMS) criteria. Factors associated with MRONJ were evaluated using univariate and multivariate logistic regression analyses.

RESULTS

MRONJ was diagnosed in 26 of 1131 patients (2.3%). Patients with MRONJ had a significantly longer cumulative duration of antiresorptive therapy than those without MRONJ. Multivariable logistic regression analysis demonstrated that a longer cumulative duration of antiresorptive therapy (OR 1.03, 95% CI 1.01-1.06; p = 0.010) and a history of tooth extraction (OR 9.74, 95% CI 2.48-38.26; p = 0.001) were independently associated with MRONJ. Medication switching, drug holidays, diabetes mellitus, corticosteroid use, and immunosuppressive therapy were not independently associated with MRONJ. Among patients with MRONJ, 69.2% had stage 1 disease and 30.8% had stage 2 disease.

CONCLUSION

Longer antiresorptive treatment duration and tooth extraction were the main factors associated with MRONJ development. Careful dental assessment and multidisciplinary planning of invasive dental procedures may help reduce MRONJ risk in high-risk patients.