{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:47:34Z","timestamp":1790189254813,"version":"4.1.0"},"reference-count":77,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timi\u0219oara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Medication-related osteonecrosis of the jaw (MRONJ) is a grave complication in patients with cancer treated with antiresorptive agents, particularly after invasive dental procedures. Identifying reliable clinical factors to assess MRONJ risk remains a clinical challenge. Methods: The retrospective observational study comprised 61 oncologic patients undergoing dental extractions during antiresorptive therapy. Preoperative serum levels of 25-hydroxyvitamin D and \u03b2-C-terminal telopeptide cross-link (\u03b2-CTx), along with relevant clinical variables, were measured. The analyses included comparative tests, multivariate logistic regression to detect independent predictors of MRONJ, and ROC curve analysis to assess the model\u2019s predictive performance. Results: MRONJ was diagnosed in 18 patients (29.5%). Low preoperative vitamin D levels were significantly associated with MRONJ and remained an independent predictor in the multivariate analysis (OR = 8.74, p = 0.005). The mandibular extraction site was also identified as a significant risk factor (OR = 7.94, p = 0.007). In contrast, \u03b2-CTX levels, age, sex, cancer type, and the number of extracted teeth did not show a significant link to MRONJ development in this cohort. The comprehensive multivariate model demonstrated good discrimination capacity (AUC = 0.806). Conclusions: Preoperative vitamin D deficiency is an important independent predictor of MRONJ after dental extractions in patients with cancer receiving antiresorptive agents. Integrating metabolic biomarkers and clinical variables into predictive models may improve risk assessment and support the development of more effective preoperative prevention strategies.<\/jats:p>","DOI":"10.3390\/jcm15051712","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T15:05:27Z","timestamp":1771945527000},"page":"1712","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Preoperative Vitamin D as Predictor of MRONJ: A Retrospective Multivariate Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8529-230X","authenticated-orcid":false,"given":"Raluca","family":"Maracineanu","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300062 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serban","family":"Talpos-Niculescu","sequence":"additional","affiliation":[{"name":"Discipline of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300062 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilena","family":"Dinu\u021bi","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Pharmacology, Discipline of Biochemistry, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Pricop","sequence":"additional","affiliation":[{"name":"Discipline of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300062 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Folescu","sequence":"additional","affiliation":[{"name":"Department of Balneology, Medical Recovery and Rheumatology, Family Medicine University Clinic, Center for Preventive Medicine, Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7718-4168","authenticated-orcid":false,"given":"Alexandra-Denisa","family":"Semenescu","sequence":"additional","affiliation":[{"name":"Department of Toxicology, Drug Industry, Management, Marketing and Dermatopharmacy, Faculty of Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Research Centre for Pharmaco-Toxicological Evaluation, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivona Mihaela","family":"Hum","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300062 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/j.joms.2014.04.031","article-title":"American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw\u20142014 update","volume":"72","author":"Ruggiero","year":"2014","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/j.joms.2022.02.008","article-title":"American Association of Oral and Maxillofacial Surgeons\u2019 Position Paper on Medication-Related Osteonecrosis of the Jaws\u20142022 Update","volume":"80","author":"Ruggiero","year":"2022","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1111\/odi.12708","article-title":"Risk factors for medication-related osteonecrosis of the jaws: A systematic review","volume":"24","author":"McGowan","year":"2018","journal-title":"Oral Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.oooo.2018.11.012","article-title":"Medication-related osteonecrosis of the jaw unrelated to bisphosphonates and denosumab\u2014A review","volume":"127","author":"King","year":"2019","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/jbmr.2405","article-title":"Diagnosis and management of osteonecrosis of the jaw: A systematic review and international consensus","volume":"30","author":"Khan","year":"2015","journal-title":"J. Bone Miner. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/j.bjoms.2024.08.008","article-title":"Management of Medication-Related Osteonecrosis of the Jaw: An Overview of National and International Guidelines","volume":"62","author":"Patel","year":"2024","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.coms.2015.06.001","article-title":"Pathophysiology of Osteonecrosis of the Jaws","volume":"27","author":"Aghaloo","year":"2015","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.bone.2010.11.020","article-title":"Denosumab and bisphosphonates: Different mechanisms of action and effects","volume":"48","author":"Baron","year":"2011","journal-title":"Bone"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.joms.2009.01.007","article-title":"The pathogenesis of bisphosphonate-related osteonecrosis of the jaw: So many hypotheses, so few data","volume":"67","author":"Allen","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.oraloncology.2007.11.012","article-title":"Bisphosphonate-induced osteonecrosis of the jaws: Prospective study of 80 patients with multiple myeloma and other malignancies","volume":"44","author":"Boonyapakorn","year":"2008","journal-title":"Oral Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/j.1749-6632.2010.05835.x","article-title":"Potential pathophysiological mechanisms in osteonecrosis of the jaw","volume":"1218","author":"Landesberg","year":"2011","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_12","first-page":"2893","article-title":"Zoledronic acid induces significant and long-lasting modifications of circulating angiogenic factors in cancer patients","volume":"9","author":"Santini","year":"2003","journal-title":"Clin. Cancer Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/S0278-2391(03)00720-1","article-title":"Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: A growing epidemic","volume":"61","author":"Marx","year":"2003","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4103\/njms.NJMS_236_20","article-title":"Medication-related osteonecrosis of the jaw: An update","volume":"13","author":"Bansal","year":"2022","journal-title":"Natl. J. Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kim, C.M., Lee, S., Hwang, W., Son, E., Kim, T.W., Kim, K., and Kim, Y.H. (2022). Obesity and periodontitis: A systematic review and updated meta-analysis. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.999455"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1111\/odi.15198","article-title":"Mechanisms Underlying Medication-Related Osteonecrosis of the Jaw","volume":"31","author":"Lee","year":"2025","journal-title":"Oral Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Yusa, K., Takeda, Y., Sasahara, N., Hemmi, T., Ishikawa, S., and Konta, T. (2025). Imbalance of Serum Bone-Metabolism-Related Factors Associated with Osteonecrosis of the Jaw. Biomedicines, 13.","DOI":"10.3390\/biomedicines13102410"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Otto, S., Aljohani, S., Fliefel, R., Ecke, S., Ristow, O., Burian, E., Troeltzsch, M., Pautke, C., and Ehrenfeld, M. (2021). Infection as an Important Factor in Medication-Related Osteonecrosis of the Jaw (MRONJ). Medicina, 57.","DOI":"10.3390\/medicina57050463"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ctrv.2018.06.007","article-title":"Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases","volume":"69","author":"Otto","year":"2018","journal-title":"Cancer Treat. Rev."},{"key":"ref_20","first-page":"e542","article-title":"Serum levels of RANKL and OPG, and the RANKL\/OPG ratio in bisphosphonate-related osteonecrosis of the jaw: Are they useful biomarkers for the advanced stages of osteonecrosis?","volume":"22","author":"Bagan","year":"2017","journal-title":"Med. Oral Patol. Oral Cir. Bucal."},{"key":"ref_21","first-page":"2265","article-title":"Prevalence and risk factors of medication-related osteonecrosis of the jaw in osteoporotic and breast cancer patients: A cross-sectional study","volume":"28","author":"Soares","year":"2020","journal-title":"Support. Care Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1186\/s40001-023-01095-6","article-title":"Clinical values of serum Semaphorin 4D (Sema4D) in medication-related osteonecrosis of the jaw","volume":"28","author":"Mu","year":"2023","journal-title":"Eur. J. Med. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2397","DOI":"10.1016\/j.joms.2007.08.003","article-title":"Oral bisphosphonate-induced osteonecrosis: Risk factors, prediction of risk using serum CTX testing, prevention, and treatment","volume":"65","author":"Marx","year":"2007","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"206","DOI":"10.5125\/jkaoms.2014.40.5.206","article-title":"Drug holiday as a prognostic factor of medication-related osteonecrosis of the jaw","volume":"40","author":"Kim","year":"2014","journal-title":"J. Korean Assoc. Oral Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.joms.2014.10.034","article-title":"Bisphosphonate therapy: C-terminal telopeptide testing facilitates devising more accurate consent for extraction","volume":"73","author":"Friedlander","year":"2015","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1016\/j.joms.2015.03.015","article-title":"High C-terminal cross-linking telopeptide levels are associated with a minimal risk of osteonecrosis of the jaws in patients taking oral bisphosphonates and having exodontia","volume":"73","author":"Friedlander","year":"2015","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_27","first-page":"367","article-title":"AAOM clinical practice statement. Subject: The use of serum C-terminal telopeptide cross-link of type 1 collagen (CTX) testing in predicting risk of osteonecrosis of the jaw (ONJ)","volume":"124","author":"Bugueno","year":"2017","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s13167-019-0160-3","article-title":"Value of pre-operative CTX serum levels in the prediction of medication-related osteonecrosis of the jaw (MRONJ): A retrospective clinical study","volume":"10","author":"Salgueiro","year":"2019","journal-title":"EPMA J."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ghio, C., Gravier-Dumonceau, R., Lafforgue, P., Giorgi, R., and Pham, T. (2025). Identifying a predictive level of serum C-terminal telopeptide associated with a low risk of medication-related osteonecrosis of the jaw secondary to oral surgery: A systematic review and meta-analysis. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0318260"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1087S","DOI":"10.1093\/ajcn\/87.4.1087S","article-title":"Blood biomarkers of vitamin D status","volume":"87","author":"Zerwekh","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Michalak, F., Hnitecka, S., Dominiak, M., and Grzech-Le\u015bniak, K. (2021). Schemes for Drug-Induced Treatment of Osteonecrosis of Jaws with Particular Emphasis on the Influence of Vitamin D on Therapeutic Effects. Pharmaceutics, 13.","DOI":"10.3390\/pharmaceutics13030354"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.jsbmb.2017.01.021","article-title":"Vitamin D supplementation guidelines","volume":"175","author":"Pludowski","year":"2018","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Leszczyszyn, A., Hnitecka, S., and Dominiak, M. (2021). Could Vitamin D3 Deficiency Influence Malocclusion Development?. Nutrients, 13.","DOI":"10.3390\/nu13062122"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3892\/etm.2011.205","article-title":"Prevalence of serum vitamin D deficiency and insufficiency in cancer: Review of the epidemiological literature","volume":"2","author":"Gupta","year":"2011","journal-title":"Exp. Ther. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"7712829","DOI":"10.1155\/2024\/7712829","article-title":"Prevalence and Factors Influencing Post-Operative Complications following Tooth Extraction: A Narrative Review","volume":"2024","author":"Dignam","year":"2024","journal-title":"Int. J. Dent."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s40729-021-00323-0","article-title":"Clinical considerations for medication-related osteonecrosis of the jaw: A comprehensive literature review","volume":"7","author":"Kawahara","year":"2021","journal-title":"Int. J. Implant. Dent."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.jormas.2017.06.012","article-title":"Update MRONJ and perspectives of its treatment","volume":"118","author":"Voss","year":"2017","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"97","DOI":"10.4103\/2231-0762.178742","article-title":"Medication-related osteonecrosis of the jaw: Clinical and practical guidelines","volume":"6","author":"Rosella","year":"2016","journal-title":"J. Int. Soc. Prev. Community Dent."},{"key":"ref_39","first-page":"2684924","article-title":"The dental management of patients at risk of medication-related osteonecrosis of the jaw: New paradigm of primary prevention","volume":"2018","author":"Panzarella","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14476\/jomp.2022.47.1.1","article-title":"Medication-Related Osteonecrosis of the Jaws: A Literature Review","volume":"47","author":"Kim","year":"2022","journal-title":"J. Oral Med. Pain."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1359\/jbmr.090728","article-title":"Bone mineralization defects and vitamin D deficiency: Histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients","volume":"25","author":"Priemel","year":"2010","journal-title":"J. Bone Miner. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1016\/j.jcms.2017.09.015","article-title":"Vitamin D (25-OHD) deficiency may increase the prevalence of medication-related osteonecrosis of the jaw","volume":"45","author":"Heim","year":"2017","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e12877","DOI":"10.1016\/j.heliyon.2023.e12877","article-title":"Vitamin D and neurodegenerative diseases","volume":"9","author":"Wang","year":"2023","journal-title":"Heliyon"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ao, T., Kikuta, J., and Ishii, M. (2021). The Effects of Vitamin D on Immune System and Inflammatory Diseases. Biomolecules, 11.","DOI":"10.3390\/biom11111624"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Dallavalasa, S., Tulimilli, S.V., Bettada, V.G., Karnik, M., Uthaiah, C.A., Anantharaju, P.G., Nataraj, S.M., Ramashetty, R., Sukocheva, O.A., and Tse, E. (2024). Vitamin D in Cancer Prevention and Treatment: A Review of Epidemiological, Preclinical, and Cellular Studies. Cancers, 16.","DOI":"10.3390\/cancers16183211"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"106308","DOI":"10.1016\/j.jsbmb.2023.106308","article-title":"The impact of vitamin D on cancer: A mini review","volume":"231","author":"Seraphin","year":"2023","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1016\/j.ejca.2005.01.017","article-title":"Plasma 25-hydroxy vitamin D concentrations, vitamin D receptor genotype and breast cancer risk in a UK Caucasian population","volume":"41","author":"Lowe","year":"2005","journal-title":"Eur. J. Cancer"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1111\/j.1365-2141.2008.07214.x","article-title":"Prevalence and significance of vitamin D deficiency in multiple myeloma patients","volume":"142","author":"Badros","year":"2008","journal-title":"Br. J. Haematol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Vincenzi, F., Smirne, C., Tonello, S., and Sainaghi, P.P. (2026). The Role of Vitamin D in Autoimmune Diseases. Int. J. Mol. Sci., 27.","DOI":"10.3390\/ijms27010555"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Michalak, F., Dominiak, M., Kiryk, J., Popecki, P., Kubicki, D., Matys, J., and Grzech-Le\u015bniak, K. (2025). The Influence of Vitamin D Levels and Supplementation on the Treatment of Patients Affected by MRONJ. Appl. Sci., 15.","DOI":"10.3390\/app15020670"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"154","DOI":"10.4103\/njcp.njcp_374_19","article-title":"Changes in serological bone turnover markers in bisphosphonate induced osteonecrosis of the jaws: A case control study","volume":"23","author":"Demircan","year":"2020","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.mehy.2018.04.023","article-title":"Vitamin D supplementation: Hypothetical effect on medication-related osteonecrosis of the jaw","volume":"116","author":"Carballo","year":"2018","journal-title":"Med. Hypotheses"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1038\/s41598-021-03966-6","article-title":"Osteonecrosis development by tooth extraction in zoledronate treated mice is inhibited by active vitamin D analogues, anti-inflammatory agents or antibiotics","volume":"12","author":"Soma","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.adaj.2016.02.011","article-title":"Assessing the utility of serum C-telopeptide cross-link of type 1 collagen as a predictor of bisphosphonate-related osteonecrosis of the jaw: A systematic review and meta-analysis","volume":"147","author":"Enciso","year":"2016","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1007\/s00784-022-04383-3","article-title":"Is serum C-terminal telopeptide cross-link of type 1 collagen a reliable parameter for predicting the risk of medication-related osteonecrosis of the jaws? A systematic review and meta-analysis of diagnostic test accuracy","volume":"26","author":"Alves","year":"2022","journal-title":"Clin. Oral Investig."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/j.adaj.2019.03.006","article-title":"Serum C-terminal cross-linking telopeptide level as a predictive biomarker of osteonecrosis after dentoalveolar surgery in patients receiving bisphosphonate therapy: Systematic review and meta-analysis","volume":"150","author":"Awad","year":"2019","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.oooo.2018.08.015","article-title":"Prevalence, initiating factor, and treatment outcome of medication-related osteonecrosis of the jaw-a 4-year prospective study","volume":"126","author":"Hallmer","year":"2018","journal-title":"Oral Surg Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Ciobanu, G.A., Camen, A., Ionescu, M., Vlad, D., Munteanu, C.M., Gheorghi\u021b\u0103, M.I., Lungulescu, C.V., Staicu, I.E., Sin, E.C., and Chivu, L. (2023). Risk Factors for Medica-tion-Related Osteonecrosis of the Jaw\u2014A Binomial Analysis of Data of Cancer Patients from Craiova and Constanta Treated with Zoledronic Acid. J. Clin. Med., 12.","DOI":"10.3390\/jcm12113747"},{"key":"ref_59","first-page":"2","article-title":"American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws\u20142009 update","volume":"67","author":"Ruggiero","year":"2009","journal-title":"J Oral Maxillofac. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1016\/j.joms.2020.12.045","article-title":"Factors Influencing Severity of Medication-Related Osteonecrosis of the Jaw: A Retrospective Study","volume":"79","author":"Feng","year":"2021","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_61","first-page":"e6944","article-title":"Medication-related Osteonecrosis of the Jaw: A Review","volume":"12","author":"AlDhalaan","year":"2020","journal-title":"Cureus"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Lon\u010dar Brzak, B., Horvat Aleksijevi\u0107, L., Vindi\u0161, E., Kordi\u0107, I., Grani\u0107, M., Vidovi\u0107 Juras, D., and Andabak Rogulj, A. (2023). Osteonecrosis of the Jaw. Dent. J., 11.","DOI":"10.3390\/dj11010023"},{"key":"ref_63","first-page":"112","article-title":"Evaluation of MRONJ Risk and Associated Factors in Patients Receiving Antiresorptive and\/or Antiangiogenic Drug Therapy: A Retrospective Cohort Study","volume":"38","author":"Ekici","year":"2023","journal-title":"Turk. J. Oncol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.joms.2021.12.007","article-title":"Prevalence, Incidence Rate, and Risk Factors of Medication-Related Osteonecrosis of the Jaw in Patients with Osteoporosis and Cancer: A Nationwide Population-Based Study in Japan","volume":"80","author":"Ishimaru","year":"2022","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_65","first-page":"1","article-title":"Predictive risk factors of medication-related osteonecrosis of the jaw","volume":"5","year":"2019","journal-title":"Int. Dent. Med. J. Adv. Res."},{"key":"ref_66","first-page":"56","article-title":"Biphosphonates related osteonecrosis of the jaw in cancer patients\u2014Epidemiological study","volume":"14","author":"Ciobanu","year":"2022","journal-title":"Rom. J. Oral Rehabil."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.jds.2023.04.026","article-title":"Risk factors for dental findings of the development of medication-related osteonecrosis of the jaw: Investigation of 3734 teeth in cancer patients receiving high dose antiresorptive agents","volume":"19","author":"Otsuru","year":"2024","journal-title":"J. Dent. Sci."},{"key":"ref_68","first-page":"33","article-title":"Bisphosphonate-related osteonecrosis of the jaws: A potential alternative to drug holidays","volume":"61","author":"Damm","year":"2013","journal-title":"Gen. Dent."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1093\/annonc\/mdr435","article-title":"Incidence, risk factors, and outcomes of osteonecrosis of the jaw: Integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases","volume":"23","author":"Saad","year":"2012","journal-title":"Ann. Oncol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"2270","DOI":"10.1200\/JCO.19.01186","article-title":"Medication-Related Osteonecrosis of the Jaw: MASCC\/ISOO\/ASCO Clinical Practice Guideline","volume":"37","author":"Yarom","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Campisi, G., Mauceri, R., Bertoldo, F., Bettini, G., Biasotto, M., Colella, G., Consolo, U., Di Fede, O., Favia, G., and Fusco, V. (2020). Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17165998"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.jcms.2010.05.009","article-title":"Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: Not just a sporadic coincidence\u2014A multi-centre study","volume":"39","author":"Otto","year":"2011","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Maracineanu, R., Tudor, A., Hum, I., Urtila, F., Streian, F., Talpos-Niculescu, S., and Motoc, M. (2025). Platelet-Rich Fibrin in MRONJ management: A prospective comparative study on its effectiveness in prevention and treatment. Medicina, 61.","DOI":"10.3390\/medicina61040625"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Kammerhofer, G., Vegh, D., B\u00e1nyai, D., V\u00e9gh, \u00c1., Joob-Fancsaly, A., Hermann, P., Geczi, Z., Hegedus, T., Somogyi, K.S., and Bencze, B. (2023). Association between Hyperglycemia and Medication-Related Osteonecrosis of the Jaw (MRONJ). J. Clin. Med., 12.","DOI":"10.3390\/jcm12082976"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.joms.2020.07.138","article-title":"Does Platelet-Rich Fibrin Prevent Medication-Related Osteonecrosis of the Jaw?","volume":"78","author":"Siew","year":"2020","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Crupi, A., Lanzetti, J., Todaro, D., Pera, F., and Erovigni, F.M. (2025). Dental Implant Survival and Risk of Medication-Related Osteonecrosis in the Jaws in Patients Undergoing Antiresorptive Therapy: A Systematic Review. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26083618"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/j.eprac.2025.06.003","article-title":"Dental Implant Failure and Medication-Related Osteonecrosis of the Jaw Related to Dental Implants in Patients Taking Antiresorptive Therapy for Osteoporosis: A Systematic Review and Meta-Analysis","volume":"31","author":"Mirza","year":"2025","journal-title":"Endocr. Pract."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1712\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T05:35:34Z","timestamp":1772084134000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1712"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,24]]},"references-count":77,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051712"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051712","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,24]]}}}