Risk categories

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While the overall risk of MRONJ is small, some patient groups have a higher risk than others and this may impact their subsequent oral health management.

An up-to-date medical history is essential in identifying those patients who are, or have been, exposed to anti-resorptive or anti-angiogenic drugs and to identify any additional risk factors, such as chronic use of systemic glucocorticoids.

Communication with the patient’s GMP may be required to obtain more information about the patient’s medical condition and drug regimen(s).

Low risk

A patient will be categorised as low risk if any of the following is present:

  • Patients being treated for osteoporosis or other non-malignant diseases of bone (e.g. Paget’s disease) with oral bisphosphonates for less than 5 years who are not concurrently being treated with systemic glucocorticoids.
  • Patients being treated for osteoporosis or other non-malignant diseases of bone with quarterly or yearly infusions of intravenous bisphosphonates for less than 5 years who are not concurrently being treated with systemic glucocorticoids.
  • Patients being treated for osteoporosis or other non-malignant diseases of bone with denosumab who are not being treated with systemic glucocorticoids.

N.B. Patients who have taken bisphosphonate drugs at any time in the past and those who have taken denosumab in the last nine months are allocated to a risk group as if they are still taking the drug.

Higher risk

A patient will be categorised as higher risk if any of the following is present:

  • Patients being treated for osteoporosis or other non-malignant diseases of bone (e.g. Paget’s disease) with oral bisphosphonates or quarterly or yearly infusions of intravenous bisphosphonates for more than 5 years
  • Patients being treated for osteoporosis or other non-malignant diseases of bone with bisphosphonates or denosumab for any length of time who are being concurrently treated with systemic glucocorticoids.
  • Patients being treated with anti-resorptive or anti-angiogenic drugs (or both) as part of the management of cancer
  • Patients with a previous diagnosis of MRONJ

N.B. Patients who have taken bisphosphonate drugs at any time in the past and those who have taken denosumab in the last nine months are allocated to a risk group as if they are still taking the drug.