Risk assessment and drug interruption guidelines for dentoalveolar surgery in patients with osteoporosis receiving anti-resorptive therapy

• Published in: Journal of Dental Sciences
• Main Authors: Ling-Ying Wei, Ching-Ming Chiu, Sang-Heng Kok, Hao-Hong Chang, Shih-Jung Cheng, Hung-Ying Lin, Wei-Yih Chiu, Jang-Jaer Lee
• Format: Article
• Language: English
• Published: Elsevier 2025-04-01
• Subjects: Anti-resorptive agents; Dentoalveolar surgery; Drug discontinuation; Medication-related osteonecrosis of the jaw (MRONJ); Risk assessment
• Online Access: http://www.sciencedirect.com/science/article/pii/S1991790225000340

Medication-related osteonecrosis of the jaw (MRONJ) is a rare and challenging complication of anti-resorptive therapy. This review addresses the critical issue of risk management in patients with osteoporosis who require dentoalveolar surgery while undergoing anti-resorptive therapy. Dental practitioners should be aware of these risks; however, they should not refuse treatment based solely on them. This review discusses the risks through five major factors: invasive dentoalveolar surgeries, concomitant oral infection, type of medication, duration of medication, and preoperative drug discontinuation. Additionally, we discussed the local factors associated with dental practices. Our review underscored the importance of personalized risk assessment, considering each patient's unique drug history and oral condition. Based on a comprehensive literature review and clinical evidence, we proposed specific guidelines for preoperative drug interruption tailored to different anti-resorptive agents. These recommendations aimed to balance osteoporosis management by minimizing the risk of MRONJ during oral surgical interventions and bridging the knowledge gap in managing patients with osteoporosis requiring dental care. This review will allow clinicians to improve their practice and optimize patient outcomes by providing evidence-based strategies.