Abstract
Breast cancer remains a leading cause of premature death in women globally, spurring the adoption of comprehensive treatment approaches. Despite therapeutic progress, significant challenges persist for patients, especially those with advanced breast cancer prone to bone metastases. Bisphosphonates and Denosumab are key bone-modifying agents used to target bone metabolism, reduce metastatic risk, and enhance adjuvant therapy efficacy in early-stage breast cancer. However, using these agents carries risks, including adverse events such as osteonecrosis of the jaw. Due to the impact of these drugs on the jaw bone, this condition is now known as Medication-related osteonecrosis of the jaw (MRONJ). The aim is to provide a comprehensive investigation into MRONJ in the context of breast cancer treatment, with a specific focus on the effects of antiresorptive drugs such as Bisphosphonates and Denosumab. The objective of this article is to review clinical and radiographic manifestations, evaluate the pathophysiology, determine risk factors and incidence and provide guidelines to healthcare professionals for the management and treatment of MRONJ.
Medication-related osteonecrosis of the jaw is a condition that occurs in breast cancer patients due to various risk factors. The treatment of MRONJ depends on the different stages of the condition. Recent research suggests that optimal management of patients prone to MRONJ necessitates a multidisciplinary approach, and the dentist is one of the team members who play a crucial role in patient care by assessing modifiable risk factors, establishing follow-up protocols, and maintaining open communication with oncologists. Preventive measures should be implemented before and during treatment with antiresorptive drugs. However, despite increased awareness, many doctors and dentists still have a limited understanding of MRONJ. Therefore, this research provides practical guidelines for preventing, managing, and treating MRONJ in breast cancer patients based on currently available literature. Dentists should follow specific protocols for patients undergoing antiresorptive therapy. The primary goals are to prevent MRONJ and maintain patients' quality of life. Therefore, dental students and specialists must stay updated and consider this side effect.