INTRODUCTION: The purpose of this European multicenter study was to describe the general characteristics and risk factors of MRONJ lesions as well as their clinical diagnosis and management at different European Oral and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the epidemiology, etiopathogenesis, and the current trends in the treatment of MRONJ across Europe. MATERIALS AND METHODS: The following data were registered for each patient: gender; age at MRONJ diagnosis; past medical history; indication for antiresorptive or antiangiogenic therapy; type of antiresorptive medication; local risk factor for MRONJ; MRONJ Stage; anatomic location and symptoms; treatment; surgical complications; recurrence. RESULTS: A total of 537 patients (375 females, 162 males) with MRONJ were included. Statistically significant associations were found between patients with metastatic bone disease and recurrences (P < 0.0005) and between advanced MRONJ stages (stages 2 and 3) and recurrences (P < 0.005). Statistically significant associations were also found between male gender and recurrences (P < 0.05), and between MRONJ maxillary sites and recurrences (P < 0.0000005). CONCLUSIONS: A longer mean duration of antiresorptive medications before MRONJ onset was observed in patients affected by osteoporosis, whereas a shorter mean duration was observed in all metastatic bone cancer patients, and in particular in those affected by prostate cancer with bone metastases or multiple myeloma. Surgery plays an important role for the management of MRONJ lesions.

Centre of Oral and Maxillofacial Surgery Institute of Dentistry Faculty of Medicine Vilnius university Vilnius Lithuania

Centro Medico Teknon Barcellona Spain

Department for Maxillofacial Surgery University Hospital Dubrava Zagreb Croatia

Department of Dentistry Faculty of Medicine in Hradec Kralove Charles University and University Hospital Hradec Kralove 50005 Hradec Kralove Czech Republic

Department of Oral and Maxillofacial Surgery Aalborg University Hospital Aalborg Denmark

Department of Oral surgery Faculty of Dental medicine Medical University of Plovdiv Bulgaria

Faculty of Medicine University of Novi Sad Dental Clinic of Vojvodina Novi Sad Serbia

Hasanuddin University Makassar Indonesia

KAT General Hospital Athens Greece

Maxillofacial Department in the Hospital Universitario Central de Asturias from Oviedo Asturias Spain

Medical University of Gdansk Gdansk Poland

Nantes Université CHU Nantes Service de chirurgie maxillo faciale et stomatologie F 4400 Nantes France

Université de Franche Comté CHU Besançon Chirurgie maxillo faciale stomatologie et odontologie hospitalière F 25000 Besançon France

University Medical Centre Ljubljana Ljubljana Slovenia

University of Belgrade Belgrade Serbia

University of Eastern Piedmont Novara Italy

University of Pécs Medical School Dept Oral and Maxillofacial Surgery 1 Tüzér st 7623 Pécs Hungary

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Case Report: single low-dose of denosumab as a trigger of MRONJ development in a patient with osteoporosis after bisphosphonate therapy