Impaired Osteoclastogenesis in Medication-Related Osteonecrosis and Potential Clinical Management with BMP-2

Review Impaired Osteoclastogenesis in Medication-Related Osteonecrosis and Potential Clinical Management with BMP-2 Chunfeng Xu 1, Yin Xiao 2, Yiqun Wu 1, Astrid Bakker 3 and Yuelian Liu 3,* 1 Department of Second Dental Center, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Centre for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 201900, China 2 School of Medicine and Dentistry & Institute for Biomedicine and Glycomics, Griffith University, Gold Coast Campus, QC 4222, Australia 3 Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands * Correspondence: [email protected]; Tel.: +31-205980626 Received: 5 November 2024; Revised: 18 December 2024; Accepted: 19 December 2024; Published: 23 December 2024 Abstract: Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but severe, complication of applying inhibitors of osteoclasts, specifically bisphosphonates and the monoclonal antibody of receptor activator of nuclear factor kappa-Β ligand (RANKL), inhibitors of angiogenesis, and some chemotherapeutics. MRONJ is painful for the patients, while current treatments are unsatisfactory. Thus, it is imperative to understand the etiology and pathogenesis of MRONJ to improve treatment options and enable prevention. Various hypotheses have been proposed over the years to elucidate the pathogenesis of MRONJ. Noticeably, impaired osteoclastogenesis shines some light on novel preventive and treatment strategies. In this review, we summarized the current understanding of the role of osteoclastogenesis in the development of MRONJ and have put forward a hypothesis concerning the application of BMP2 in the clinical management strategy for MRONJ.