Interventions for managing medication-related osteonecrosis of the jaw

Natalie H. Beth-Tasdogan, Benjamin Mayer, Heba Hussein, Oliver Zolk, Jens-Uwe Peter

Review question

What are the effects of different interventions to either prevent or treat medication‐related osteonecrosis of the jaw compared with each other or compared with no treatment or an inactive intervention ('placebo')?


Medication‐related osteonecrosis of the jaw (MRONJ) is severe bone damage in the jaw bone that occurs in some people as a reaction to certain medicines commonly used in the treatment of cancer and osteoporosis (a disease that makes bones fragile). It is a painful condition that can be difficult to treat. MRONJ occurs rarely in people taking some medicines for osteoporosis. However, in people receiving these drugs at higher doses for cancer‐related conditions, the risk of MRONJ may be higher and has been reported to occur in up to five in 100 individuals. It is important to identify effective preventive measures to reduce the risk of MRONJ, and better treatments for those who have it.

This is an update of our review first published in 2017. It is based on a search for articles that was conducted most recently in June 2021.

Study characteristics

Working with Cochrane Oral Health, we searched for studies that had been published up to June 2021. We found five studies that focused on the prevention of MRONJ and eight studies that tested treatments for MRONJ. The studies involved 1668 adults, with the smallest study having 13 participants and the largest study having 700 participants. Most study participants were women, but one study was of men with prostate cancer receiving bisphosphonate infusions (given by drip into a vein). All but two studies included only participants treated with bisphosphonates (used to support treatment and reduce risk of fracture and bone pain), although several other drugs are also known to induce MRONJ. Two trials also included patients treated with bisphosphonates or denosumab.

Key results

One study provided very low‐certainty evidence that dental examinations at three‐month intervals and preventive treatments (antibiotics before dental extractions and the use of techniques for wound closure that avoid exposure and contamination of bone) are more effective than standard care for reducing the number of cases with MRONJ in a group of people receiving intravenous bisphosphonates for cancer‐related conditions. In the experimental group, which received preventive care consisting of antibiotics and specific wound closure, fewer people developed MRONJ: two participants per 100 who underwent close monitoring developed MRONJ compared to 23 participants per 100 in the control group (standard care).

There was insufficient evidence to conclude that the use of the other interventions investigated would reduce the risk of MRONJ or would improve healing of MRONJ.

Certainty of the evidence

The certainty of the evidence was low or very low. This was due to limitations in how the studies were designed and run. For example, some participants changed groups during the study, some participants did not finish the study, and the outcomes were measured at different follow‐up times. In addition, most of the studies had only a small number of participants.

Read the full review.

Beth-Tasdogan NH, Mayer B, Hussein H, Zolk O, Peter J-U. Interventions for managing medication‐related osteonecrosis of the jaw. Cochrane Database of Systematic Reviews 2022, Issue 7. Art. No.: CD012432. DOI: 10.1002/14651858.CD012432.pub3.