Osteoporosis on antiresorptives (MRONJ risk)

Medication-related osteonecrosis of the jaw (MRONJ) requires ALL THREE features (AAOMS 2022 / ADA): (1) current or previous antiresorptive and/or antiangiogenic therapy; (2) exposed bone, or bone that can be probed through an intraoral or extraoral fistula, in the maxillofacial region persisting >8 weeks; (3) no history of radiation therapy to the jaws and no obvious metastatic disease to the jaws. Risk is stratified by indication: osteoporosis dosing (oral bisphosphonates like alendronate/risedronate, IV zoledronic acid 5mg once-yearly, or denosumab 60mg q6months — MRONJ is RARE, ~0.001–0.01%) vs oncology dosing (high-dose IV bisphosphonates/denosumab 120mg monthly — much HIGHER risk, ~1–15%). Prevention = risk assessment + oral-health optimization + atraumatic technique. Major references: AAOMS 2022 position paper and SDCEP 2017 (extant, 2024 supplement).