Risk factors for medication-related osteonecrosis of the jaw in patients receiving bisphosphonates and/or denosumab: a systematic review of the literature

Background. Medication-related osteonecrosis of the jaw (MRONJ) remains a rare but clinically relevant complication of antiresorptive treatment. Its risk is shaped by the interaction of drug exposure, oral inflammatory burden, and systemic comorbidity. Objective. To synthesize evidence on risk factors for MRONJ in patients receiving bisphosphonates and/or denosumab and to derive a practice-oriented prevention algorithm. Material and methods. A PRISMA 2020-oriented systematic review was conducted in PubMed/MEDLINE, Scopus, Web of Science, and eLIBRARY.ru, supplemented by CyberLeninka and hand-searching of reference lists. Guidelines, systematic reviews/meta-analyses, cohort studies, and case-control studies focused on adult patients receiving bisphosphonates and/or denosumab were eligible. Thirty-seven records, including 17 Russian VAK-indexed publications, were included in the qualitative synthesis. Results. The most consistent risk factors were oncology-dose exposure, parenteral high-dose regimens, treatment duration and cumulative exposure, sequential antiresorptive/antiangiogenic therapy, active oral inflammatory disease, tooth extraction and other invasive dental procedures, as well as diabetes, smoking, anemia, and long-term corticosteroid use. Evidence on age, sex, vascular factors, and individual laboratory markers remains heterogeneous. Conclusion. MRONJ risk is multifactorial. The most applicable preventive measures are pre-treatment dental optimization, risk stratification by indication and drug class, scheduled monitoring, and a standardized management algorithm for invasive dental care.