Single-center experience in the management of medication-related osteonecrosis of the jaw.

Background

Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of antiresorptive therapy, yet optimal management remains controversial. The authors evaluated treatment outcomes, with an emphasis on the role of surgical intervention.

Methods

A retrospective cohort study was conducted at a single tertiary referral center, including patients treated for MRONJ from 2009 through 2025. Lesions were defined as improved if clinical downstaging occurred and as resolved if complete mucosal coverage without infection or exposed necrotic bone was achieved. Treatment modalities and outcomes were compared between osteoporosis- and oncology-associated MRONJ.

Results

A total of 222 patients with MRONJ were analyzed: 139 had oncology-associated MRONJ (62.6%) and 83 had osteoporosis-associated MRONJ (37.4%). Oncology-associated MRONJ was more frequently managed conservatively with systemic antibiotics (21.6% vs 6.0%; P = .002), whereas patients with osteoporosis-associated MRONJ more often underwent surgical treatment (94.0% vs 78.4%; P = .002). Overall, 84.6% of patients improved and 69.4% achieved clinical resolution. Resolution was significantly higher in osteoporosis-associated MRONJ (80.7% vs 62.6%; P = .005). Surgical intervention was associated with favorable outcomes, accounting for 87.8% of improved cases and 94.2% of resolved cases (P < .001). Marginal mandibulectomy and partial maxillectomy were most associated with complete resolution (50.0% vs 22.1% in nonhealed cases; P < .001).

Conclusions

Surgical management was associated with improved outcomes in patients with MRONJ compared with conservative approaches. Prospective studies are required to confirm the optimal timing and extent of surgical intervention. PRACTICAL IMPLICATIONS A surgical approach may be considered an important option in the management of MRONJ in appropriately selected patients.