Medical practitioners’ awareness and practices regarding bisphosphonate therapy and oral health risks: a Malaysian cross‑sectional study

BACKGROUND: Bisphosphonates are widely prescribed for osteoporosis, Paget's disease, and malignancy-related bone disease. While effective in reducing skeletal complications, they are associated with medication-related osteonecrosis of the jaw (MRONJ), a serious but preventable condition. Medical practitioners play a central role in initiating therapy, educating patients, and coordinating referrals, yet data on awareness and practices in Malaysia remain limited. OBJECTIVE: This study assessed the awareness, prescribing practices, and perceived roles of medical practitioners at a university hospital concerning oral health risks associated with bisphosphonate therapy. METHODS: A cross-sectional survey was conducted among 130 medical practitioners at a university hospital using a validated questionnaire. Participants included medical officers, Clinical Master's trainees, and specialists in medicine, orthopaedics, and primary care. The questionnaire assessed demographics, awareness of oral complications, prescribing patterns, referral behaviours, and perceived roles. Data were analysed using descriptive statistics and chi-square tests. RESULTS: Most respondents (96.2%) were aware that bisphosphonates may cause oral complications, and 94.6% identified MRONJ. However, only 58.5% reported awareness of clinical guidelines, and 23.8% felt adequately informed to manage affected patients. Oral bisphosphonates were the most frequently prescribed (77.7%), primarily for osteoporosis (95.4%), while intravenous forms were less common; at osteoporosis dosing, the risk of MRONJ with intravenous zoledronate remains very low compared to oncology regimens. Alternative therapies were considered by 67.7% of practitioners, most often denosumab and teriparatide. Preventive practices were inconsistent: 73.8% educated patients about MRONJ, 49.2% advised pretreatment dental evaluation, and 52.3% referred patients for dental screening. Awareness was significantly associated with prescribing frequency, while referral behaviours varied by department, position, and age. CONCLUSION: Medical practitioners demonstrated high recognition awareness of MRONJ but notable gaps in guideline literacy, preventive practices, and interprofessional collaboration. These findings highlight the need for structured education, clearer referral protocols, and stronger integration between medical and dental teams to ensure early prevention and optimal patient care.