Predicting MRONJ Recurrence: Key Risk Factors in Cancer Patients on Antiresorptive Therapy

Antiresorptive therapies, widely used in oncology for bone metastases, are associated with medication-related osteonecrosis of the jaw (MRONJ) a condition with significant clinical and public health implications. This study investigates recurrence rates and risk factors for MRONJ in cancer patients, aiming to inform preventive strategies and improve health outcomes. A retrospective cohort study was conducted on 62 patients diagnosed with MRONJ at the A. Gemelli University Hospital between 2021 and 2023. Inclusion criteria were age >18, use of antiresorptive drugs, and clinical diagnosis of MRONJ. Data from electronic health records were analyzed using STATA 18. Logistic regression and stepwise models were used to identify recurrence predictors, adjusting for age, sex, smoking, and other confounders. Model performance was assessed through Hosmer-Lemeshow tests and ROC curve analysis. Median patient age was 68; 35.3% were male. Most presented with single lesions (66.1%), mainly in the mandible (45.2%). Stage 1 was most common (46.8%), while Stage 3 accounted for 16.1%. Recurrence occurred in 43.6% of cases and was significantly associated with older age and multifocal lesions (p < 0.05). Each additional year of age increased recurrence risk by 5.8%. The predictive model showed good reliability (AUC = 0.78). Smoking, comorbidities, and dental prostheses were not significant predictors. MRONJ poses a growing concern in oncology and oral health, particularly among aging populations. This study highlights the importance of early detection, risk stratification, and continuous dental surveillance as public health priorities. The strong association between recurrence and age/multifocality underlines the need for targeted interventions and education of healthcare providers. Limitations include the small, monocentric sample and lack of long-term data. Broader, multicenter studies are needed to guide policy and improve integrated care pathways for vulnerable patients.

Key messages

• MRONJ recurrence is frequent among cancer patients receiving antiresorptive therapies, with older age and multifocal lesions emerging as significant predictors of increased risk.

• Early risk stratification and continuous dental monitoring are essential to reduce recurrence and improve outcomes, highlighting the need for integrated oncologic–oral care pathways.