Objectives:Medication-Related Osteonecrosis of the Jaw (MRONJ) is a serious and debilitating condition most often associated with dentoalveolar trauma or surgical interventions such as tooth extractions. Although MRONJ has been extensively investigated, spontaneous MRONJ—occurring without any identifiable local precipitating factors—remains poorly understood and scarcely researched. The clinical importance of spontaneous MRONJ requires better understanding to enhance prevention and management approaches. This study aimed to identify associations between known MRONJ-inducing medications, their clinical administration methods, treatment duration, therapeutic indication, and the development of spontaneous MRONJ. To date, this represents the largest single-center case-control study focused specifically on trauma-independent MRONJ.
Methods:
This retrospective case-control study was conducted at the University of California, Los Angeles (UCLA) School of Dentistry and included patients diagnosed with MRONJ between 2012 and 2024. Cases were defined as patients with a definitive diagnosis of MRONJ (Stage I to III per AAOMS criteria) who had not undergone any dentoalveolar procedures, including extractions, implant placement, or intraoral trauma following initiation of MRONJ-associated medications. The control group included patients who received the same medications without developing MRONJ and without a dental trauma history. The study excluded patients who received medications not related to MRONJ and patients who received head and neck radiation or had jaw metastases or chronic necrotic conditions. The research team extracted demographic information along with comorbidities and medication details, including type, indication of treatment, administration route, and duration of treatment, from clinical records. The research included 121 spontaneous MRONJ cases together with 54 control participants. The statistical analysis used Firth’s logistic regression to determine which factors were significantly linked to spontaneous MRONJ.
Results:
The analysis showed that the antiresorptive agent zoledronate (Reclast) had the most significant relationship with spontaneous MRONJ. The analysis showed that subcutaneous drug administration was found to significantly reduce the risk of spontaneous MRONJ (p < 0.05). Among medical indications, colon cancer showed the highest effect size (β = 2.20), followed by osteoporosis (β = 0.83); however, none of the medical conditions were statistically significant predictors (p > 0.05), and confidence intervals were wide. While longer durations of medication use (1–3 years) trended toward higher MRONJ risk, the correlation did not reach statistical significance. The research results demonstrate that spontaneous MRONJ develops from multiple factors, which include drug pharmacokinetics together with systemic disease and exposure duration.
Conclusion:This study shows that medication classification together with administration route and treatment duration significantly influences the development of spontaneous MRONJ. The results demonstrate the need for personalized risk evaluations and team-based approaches before starting antiresorptive or antiangiogenic treatments. The research findings from this study enhance the understanding of MRONJ while providing guidance for its early detection and prevention and management strategies. These results can inform predictive algorithms by identifying key patient factors—such as medication type, treatment duration, and administration route—that contribute to spontaneous MRONJ risk.