Understanding about the risks, prevention and management of Medication Related Osteonecrosis is still developing.
This article is one of the most referenced and utilised papers around the world for guiding the prevention, diagnosis and management of MRONJ.
Publications about the risks of taking anti-resorptive medications
Guidelines from the College of General Practitioners
Royal Australian College of General Practitioners Clinical Guidelines.
The management of patients on denusomab for osteoporosis requiring dental extractions.
484 patients had 963 extractions and were advised to delay any extractions until after six months from their last injection of denusomab. They were also advised to delay their next injection for four weeks after their extraction to allow the socket to heal. There were 10 cases of MRONJ. These patients were all over 70 and nine of 10 were female. Nine of the ten had been on denusomab with or without prior oral bisphosphonates for greater than 4 years with the other being severely immune compromised. Four had their extractions prior to six months after their last injection and two had their next injection within two weeks of the extraction. Hence the advice not to delay denusomab resulted in six of the 10 cases of MRONJ.