Osteoporosis Management after the Occurrence of Medication-Related Osteonecrosis of the Jaw - A 13-Year Experience at a Tertiary Center

Sep 29, 2026

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Osteoporosis management must balance fracture prevention against the risk of medication-related osteonecrosis of the jaw (MRONJ), a rare complication that can substantially impair quality of life. This study retrospectively examined post-MRONJ osteoporosis management in patients treated at a tertiary center from 2010 to 2022, evaluating subsequent treatment strategies, fracture events, and bone mineral density changes. Findings assessed how continuation of anti-osteoporosis therapy, regimen selection, and recurrence associations relate to fracture probability after MRONJ.

LanguageEnglish

CategoryHealthcare

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Pages17

Reading Time43 min

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Original Article Endocrinol Metab 2025;40:974-990 [https://doi.org/10.3803/EnM.2024.2262](https://doi.org/10.3803/EnM.2024.2262)[ ](https://doi.org/10.3803/EnM.2024.2262)[pISSN 2093-596X](pISSN 2093-596X) · eISSN 2093-5978 Osteoporosis Management after the Occurrence of Medication-Related Osteonecrosis of the Jaw: A 13-Year Experience at a Tertiary Center Chun Ho Wong 1, *, Kimberly Hang Tsoi 1, *, Jingya Jane Pu2, *, Nancy Su Jiang1, Stacey SheungYi Chan1, Connie Hong Nin Loong1, Xincheng Zou1, Carol Ho Yi Fong1, Eunice Ka Hong Leung1, Alan Chun Hong Lee1, Chi Ho Lee1, Kathryn Choon Beng Tan1, Yu Cho Woo1, Yu-xiong Su2, David Tak Wai Lui1 1Division of Endocrinology and Metabolism, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong; 2Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Background: We investigated osteoporosis management strategies and clinical outcomes following the occurrence of medicationrelated osteonecrosis of the jaw (MRONJ) . Methods: We retrospectively studied individuals diagnosed with MRONJ during osteoporosis treatment who were managed in the Osteoporosis Center or the Oral Maxillofacial Surgery & Dental Unit at Queen Mary Hospital in Hong Kong between 2010 and 2022. We examined subsequent osteoporosis management plans, fracture events, and bone mineral density (BMD) . Results: Thirty-six individuals were included (mean age, 78.5 years; 94.4% women) . The estimated prevalence of MRONJ was 0.26% . All patients had been exposed to bisphosphonates, and seven had also received denosumab before MRONJ. Following MRONJ, only 14 individuals continued anti-osteoporosis treatment, a decision influenced by a higher fracture probability at MRONJonset. The most common regimen was a teriparatide-raloxifene sequence (n = 8): three patients achieved stable BMD, four achieved improving BMD, and one exhibited a mixed response. The patient with a mixed BMD response had also been treated with denosumab. Six patients sustained incident fractures after MRONJ, and these patients had lower BMD T-scores than their counterparts. Two patients experienced MRONJ recurrence, which was associated with the resumption ofbisphosphonate or denosumab therapy after MRONJ. These patients had higher BMD T-scores than those who did not experience MRONJ recurrence. Conclusion: MRONJ is challenging because high fracture risk necessitates discontinuation of antiresorptive agents. Teriparatide followed by raloxifene may be a reasonable regimen. Individualised decisions in osteoporosis management after MRONJ are required to balance fracture risk reduction with minimising MRONJ recurrence. | Keywords: Osteoporosis; Osteonecrosis of jaw; Bisphosphonate; Denosumab; Fracture; Bone mineral density | | | --- | --- | | Received: 2 December 2024, Revised: 17 February 2025, Accepted: 26 March 2025
Corresponding authors: David Tak Wai Lui
Department of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong Tel: +852-22554704, Fax: +852-28162187, E-mail: dtwlui@hku.hk
Yu-xiong Su
Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Hong Kong
Tel: +852-28590262, Fax: +852-28575570, E-mail: richsu@hku.hk
*These authors contributed equally to this work. | Copyright © 2025 Korean Endocrine Society
This is an Open Access article distributed under the terms of
the Creative Commons Attribution Non-Commercial License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
| 974 [www.e-enm.org](www.e-enm.org) Osteoporosis Management Post-ONJ INTRODUCTION Osteoporosis is a global health issue that is becoming increasingly prevalent in ageing societies. It

FAQs

What did the study investigate about osteoporosis management after MRONJ?

The study investigated osteoporosis management strategies and clinical outcomes following the occurrence of medication-related osteonecrosis of the jaw (MRONJ). It focused on subsequent management plans, fracture events, and bone mineral density (BMD).

How was the study conducted and who were included?

The study retrospectively reviewed individuals diagnosed with MRONJ during osteoporosis treatment. Patients were managed at a tertiary center between 2010 and 2022, and subsequent outcomes were analyzed.

What treatment approach did the results highlight after MRONJ?

After MRONJ, only some patients continued anti-osteoporosis therapy, reflecting higher fracture probability at MRONJ onset. The most common regimen was a teriparatide-raloxifene sequence, and individualized decisions were emphasized to balance fracture risk reduction with minimizing MRONJ recurrence.

Sep 29, 2026

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