Medication-related osteonecrosis of the jaw unrelated to bisphosphonates and denosumab-a review

The link between medication-related osteonecrosis of the jaw (MRONJ) and bone modulating drugs, such as bisphosphonates and denosumab, is well established, and the number of reported cases is increasing. The development of novel medications used in the treatment of cancer, as well as autoimmune and bone conditions, has led to more cases of MRONJ being reported. However, in addition to this group of medications, increasing numbers of new agents in cancer therapy, such as antiangiogenic agents, have also been implicated in the development of MRONJ. As these newer agents with similar mechanisms are routinely used, the numbers of reported cases will likely rise further. This article aims to identify and summarize the drugs implicated in MRONJ, besides bisphosphonates and denosumab. A wide range of medications classified as tyrosine kinase inhibitors, monoclonal antibodies, mammalian target of rapamycin inhibitors, radiopharmaceuticals, selective estrogen receptor modulators, and immunosuppressants have been implicated in MRONJ. It remains crucial that oral health care providers are aware of these new medications and their associated risks to manage their patients appropriately.