Underestimated Roles of Osteocytes in Medication-Related Osteonecrosis of the Jaw

Perspective Underestimated Roles of Osteocytes in Medication-Related Osteonecrosis of the Jaw Chunfeng Xu and Yiqun Wu * Department of Second Dental Center, 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 * Correspondence: [email protected] Received: 18 February 2025; Revised: 10 March 2025; Accepted: 11 March 2025; Published: 14 March 2025 Abstract: Medication-related osteonecrosis of the jaw (MRONJ) is a grievous complication after the long-duration administration of some bone-modifying agents, mainly containing bisphosphonates (BPs), denosumab, angiogenesis inhibitors, immunosuppressors, glucocorticoids, and chemotherapeutics. Its prevalence is rare but mounting due to the widespread application of MRONJ-associated drugs in the aging population and cancer patients. Although MRONJ is excruciating, there has been no specific and efficient remedy for it. To date, the understanding of MRONJ is not thorough, and various theories on MRONJ have been proposed, among which impaired bone remodeling as a result of inhibited osteoclast generation and activity is the predominant one. However, the role of osteocytes in MRONJ has been omitted, given their crucial roles in governing bone metabolism: they not only communicate with osteoblasts for bone formation but also promote osteoclastogenesis.