{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:57:47Z","timestamp":1787169467822,"version":"build-2736575974"},"reference-count":19,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"unspecified","delay-in-days":92,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,3,14]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Medication-related osteonecrosis of the jaws (MRONJ) can be a debilitating condition which is challenging to manage. While vast literature exists surrounding MRONJ, many studies have small participant numbers and are heterogeneous in design, leaving unanswered questions and making evidence-based practice challenging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Provide an overview of recent MRONJ incidence data, over a 5-year period, identify potential issues in reporting MRONJ cases and propose changes for future reporting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Studies with original data regarding MRONJ incidence published from 2015 to 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Sources of evidence<\/jats:title>\n                    <jats:p>A search was conducted on MEDLINE Ovid, the National Library of Medicine's bibliographic database, using a combination of medical subject headings (MeSH) and free text terms and run on 29 April 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Charting method<\/jats:title>\n                    <jats:p>Each title was hand-screened, and the abstract\/article in full was reviewed to establish suitability for inclusion by two authors. Data extraction by two reviewers included author, year of publication, study design, population\u2014cancer\/osteoporosis\/both\/other, description of population, sampling method, exclusion criteria, single centre Y\/N, reported rate of MRONJ cases\/number of participants, details of diagnosis and diagnostic criteria, duration of follow-up and location of study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The initial search returned 1186 titles, detailed screening and inclusion of additions resulted in 92 articles for data extraction. Mean incidence of MRONJ across all studies was 4.34% (median 2.42%, range 0% to 31.80%). The mean incidence based on patient group was oncology 6.22% (32 954 participants), osteoporosis 0.58% (498 443 participants), oncology and osteoporosis 7.21% (54 7651 participants) and other, including autoimmune, inflammatory and other bone conditions, 2.55% (4487 participants). Further analysis showed incidence influenced by study size (&gt;500 participants), diagnostic criteria used, location of study and other factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Heterogeneity in studies reporting MRONJ incidence impacts results and conclusions. Standardised, contemporaneous reporting of MRONJ cases would eliminate this variation and provide valuable insight into the epidemiology, natural history and outcomes of these patients, supporting evidence-based management and service provision of patients affected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-002009","type":"journal-article","created":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T08:26:49Z","timestamp":1743841609000},"page":"e002009","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["The issue with incidence: a scoping review of reported medication-related osteonecrosis of the jaws (MRONJ) incidence around the globe"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0670-7280","authenticated-orcid":false,"given":"Ailish Suzanne Emuss","family":"Clark","sequence":"first","affiliation":[{"name":"The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK"},{"name":"Oral Surgery, The University of Edinburgh Edinburgh Dental Institute, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Marie","family":"Glenny","sequence":"additional","affiliation":[{"name":"The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,5]]},"reference":[{"key":"2025083110382498000_3.1.e002009.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-2391(03)00720-1"},{"key":"2025083110382498000_3.1.e002009.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2014.04.031"},{"key":"2025083110382498000_3.1.e002009.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2006.11.003"},{"key":"2025083110382498000_3.1.e002009.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2022.02.008"},{"key":"2025083110382498000_3.1.e002009.5","doi-asserted-by":"crossref","first-page":"11709","DOI":"10.3390\/ijerph191811709","article-title":"Oral-Health-Related Quality of Life in Patients with Medication-Related Osteonecrosis of the Jaw: A Prospective Clinical Study","volume":"19","author":"Winter","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2025083110382498000_3.1.e002009.6","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s00784-017-2325-6","article-title":"Stage-specific therapeutic strategies of medication-related osteonecrosis of the jaws: a systematic review and meta-analysis of the drug suspension protocol","volume":"22","author":"Ramaglia","year":"2018","journal-title":"Clin Oral Investig"},{"key":"2025083110382498000_3.1.e002009.7","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1038\/sj.bdj.2017.79","article-title":"Awareness of medication related osteonecrosis of the jaws (MRONJ) amongst general dental practitioners","volume":"222","author":"Tanna","year":"2017","journal-title":"Br Dent J"},{"key":"2025083110382498000_3.1.e002009.8","unstructured":"Scottish Dental Clinical Effectiveness Programme . SDCEP oral health management of patient at risk of MRONJ guidance: SDCEP. Available: http:\/\/www.sdcep.org.uk\/wp-content\/uploads\/2017\/04\/SDCEP-Oral-Health-Management-of-Patients-at-Risk-of-MRONJ-Guidance-full.pdf [Accessed 15 Jan 2019]."},{"key":"2025083110382498000_3.1.e002009.9","unstructured":"U.S. Department of Health and Human Services, NIoH, National Cancer Institute . Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. 2020. Available: https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/ctc.htm"},{"key":"2025083110382498000_3.1.e002009.10","doi-asserted-by":"crossref","DOI":"10.1038\/s41368-020-00093-2","article-title":"Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw","volume":"12","author":"He","year":"2020","journal-title":"Int J Oral Sci"},{"key":"2025083110382498000_3.1.e002009.11","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab888"},{"key":"2025083110382498000_3.1.e002009.12","unstructured":"Foundation IO . Scorecard for osteoporosis in Europe (SCOPE) epidemiology, burden, and treatment of osteoporosis in the United Kingdom UK report.pdf (osteoporosis.foundation). International Osteoporosis Foundation; 2021."},{"key":"2025083110382498000_3.1.e002009.13","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.2405"},{"key":"2025083110382498000_3.1.e002009.14","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.3390\/jcm12041416","article-title":"Medication-Related Osteonecrosis of the Jaws (MRONJ) in Children and Young Patients-A Systematic Review","volume":"12","author":"Rosales","year":"2023","journal-title":"J Clin Med"},{"key":"2025083110382498000_3.1.e002009.15","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1016\/j.jormas.2022.03.020","article-title":"Incidence and risk factors associated to Medication-Related Osteo Necrosis of the Jaw (MRONJ) in patients with osteoporosis after tooth extractions. A 12-months observational cohort study","volume":"123","author":"Cuozzo","year":"2022","journal-title":"J Stomatol Oral Maxillofac Surg"},{"key":"2025083110382498000_3.1.e002009.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2022.08.010"},{"key":"2025083110382498000_3.1.e002009.17","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.3390\/jcm11082145","article-title":"Identification of Potentially Pathogenic Variants Associated with Recurrence in Medication-Related Osteonecrosis of the Jaw (MRONJ) Patients Using Whole-Exome Sequencing","volume":"11","author":"Kim","year":"2022","journal-title":"J Clin Med"},{"key":"2025083110382498000_3.1.e002009.18","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.sdentj.2022.01.003","article-title":"Medication-Related Osteonecrosis of the Jaw (MRONJ): A Review of Pathophysiology, Risk Factors, Preventive Measures and Treatment Strategies","volume":"34","author":"AlRowis","year":"2022","journal-title":"Saudi Dent J"},{"key":"2025083110382498000_3.1.e002009.19","doi-asserted-by":"crossref","first-page":"4097","DOI":"10.3390\/cells11244097","article-title":"Reporting Criteria for Clinical Trials on Medication-Related Osteonecrosis of the Jaw (MRONJ): A Review and Recommendations","volume":"11","author":"Gaudet","year":"2022","journal-title":"Cells"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2024-002009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:38:35Z","timestamp":1756661915000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2024-002009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,4,5]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjph-2024-002009"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2024-002009","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}