Medication-Related Osteonecrosis of the Jaw Associated with Monoclonal Antibodies and Small-Molecule Inhibitors: A Literature Review

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) has evolved from an uncommon clinical entity to a well-recognized, multifactorial complication predominantly linked to antiresorptive and antiangiogenic therapies. While bisphosphonates were the first drug class linked with M.R.O.N.J., subsequent research has identified several newer therapeutic agents, specifically monoclonal antibodies (mAbs) and small-molecule inhibitors (SMIs), as significant contributors. The increasing use of these agents in oncology and metabolic bone disorders necessitates a thorough understanding of their mechanisms and association with MRONJ. This review synthesizes evidence from 25 key studies, encompassing randomized controlled trials, cohort analyses, pharmacovigilance reports, and expert consensus guidelines. Our objective is to present an evidence-based framework highlighting the incidence, how the process works, risk modifiers, signs and symptoms, diagnostic protocols, and management strategies linked to MRONJ induced by mAbs and SMIs.