BACKGROUND: Medication - related osteonecrosis of the jaw (MRONJ) is a rare but serious complication of antiresorptive and/or antiangiogenic therapy. It mainly affects oncological patients, however, it can occur in patients with metabolic bone diseases, although this is less frequent. These lesions not only significantly impair the quality of life but can also have impact on the treatment of any underlying disease. In some rare cases MRONJ can be life-threatening. There is still no ideal consensus for treatment, though surgical therapy has been mostly preferred in recent years. MATERIALS AND METHODS: A monocentric retrospective evaluation of surgical therapy of MRONJ in osteoporotic patients, treated in the time period 3/2014-3/2018 using the uniform department-specific protocol. RESULTS: 26 osteoporotic patients with 32 MRONJ lesions of stage 1 (9%), stage 2 (75%) and stage 3 (16%) were treated surgically. The maxilla: mandibula ratio was 1:2.2, in 19% of patients there was multiple jaw involvement. 69.2% of patients had received bisphosphonates, 15.4% denosumab and 15.4% had a history of both types of antiresorptive treatment. Complete healing was observed in all patients, in 9% of cases by secondary intention in the mean period of 6 weeks. The mean follow-up was 20.5 months. CONCLUSION: The presented protocol for surgical therapy was effective in the management of all MRONJ stages in the osteoporotic patients described here. The surgery is indicated as an early treatment to prevent complications and the progression of the lesions. It leads to improvement in quality of life and option to resume antiresorptive therapy if interrupted.

Clinic of Ophthalmology University Hospital and Faculty of Medicine in Pilsen Charles University Prague Alej Svobody 80 304 60 Pilsen Czech Republic

Department of Oral and Maxillofacial Surgery University Hospital and Faculty of Medicine in Pilsen Charles University Prague Alej Svobody 80 304 60 Pilsen Czech Republic

Osteocentre of the 2 nd Internal Medicine Clinic University Hospital and Faculty of Medicine in Pilsen Charles University Prague Dr Edvarda Benese 13 305 99 Pilsen Czech Republic

References provided by Crossref.org

Secukinumab Causing Medication-Related Osteonecrosis of the Jaw, in a Patient Diagnosed with Psoriasis and Rheumatoid Arthritis