Cyclopedic analysis of medication-related osteonecrosis of the jaws in patients with diabetes mellitus

Abstract

Medication-Related Osteonecrosis of the Jaw (MRONJ) is a complex condition which involves localized bone necrosis of maxilla and mandible among patients undergoing treatment for chronic debilitating diseases including multiple myeloma, breast cancer, prostate cancer and osteoporosis. Common clinical symptoms include non-healing painful socket, tooth mobility, foul oral odor, sometimes accompanied with fever and lymphadenopathy.  Higher incidence of osteonecrosis of the Jaw is associated with long term therapeutic use of bisphosphonates, Receptor Activator of Nuclear factor Kappa-? Ligand inhibitors, and antiangiogenic agents.  Bisphosphonates and Receptor Activator of Nuclear factor Kappa- ? Ligand inhibitors regulate osteoclast differentiation, bone remodeling and repair in osteoporosis. The antiangiogenic drug controls proliferation, growth and metastasis of carcinomas by suppression of angiogenic pathways. Though the exact pathology underlying MRONJ is still unknown but patients with long-term history of diabetes mellitus have shown to present deteriorating effects on bone physiology. Diabetes alters the immune response, promotes inflammation, suppress differentiation of osteoclast and bone turnover rate. In modern times, though establishing a diagnosis and ubiquitous treatment modalities are readily available for the patients with diabetes, determining the same for MRONJ has never been precise due to under-reporting of the cases. Other systemic diseases contributing as risk factors in MRONJ include rheumatoid arthritis, hypertension, auto immune disease and recently discovered Coronavirus Disease-19. The intractable course of the disease affects quality of life with proportionate impact on global medical healthcare system. Thus, diagnosis of ONJ is critical to reduce morbidity among these patients. The objective of this review is to focus on the molecular effect of drugs which escalates the risk of MRONJ among diabetic patients.