Recommendations

Risk Assessment

Refer to Section 3 of the full guidance.

Key Recommendation

Assess whether a patient taking anti-resorptive or anti-angiogenic drugs is at low risk or higher risk of developing MRONJ based on their medical condition, type and duration of drug therapy and any other complicating factors and record this in the patient’s clinical notes.
(Strong recommendation; low quality evidence)

  • Ask about past, current, or possible future use of anti-resorptive or anti-angiogenic drugs when taking or confirming a medical history.
  • Assign a level of risk based on an assessment of the medical condition that the patient is being treated for and any other complicating risk factors such as concurrent glucocorticoid medication and length of exposure to the drugs. 
    • Ensure that the assigned risk level is recorded in the patient’s clinical record
    • Be aware that any low risk patient who continues to take bisphosphonate drugs after their five-year medication review should be reclassified as higher risk
    • A flowchart to aid individual risk assessment
  • If a patient has taken anti-resorptive drugs in the past but is no longer taking them for whatever reason (i.e. completed or discontinued the course or taking a drug holiday), allocate them to a risk group as follows:
    • If a patient has taken bisphosphonates in the past, allocate them to a risk group as if they are still taking the drugs
    • If a patient has taken denosumab in the past nine months, allocate them to a risk group as if they are still taking the drug

N.B. Patients who have previously taken anti-angiogenic drugs in combination with anti-resorptive drugs should be allocated to a risk group based on their history of anti-resorptive drug use.