• dental prevention
• Osteonecrosis of the jaw

Aim. The aim of the study was to investigate the incidence of medical related
osteonecrosis of the jaw (MRONJ) after the set-up of structured programme of primary
prevention before commencement and during treatment with zoledronic acid therapy taken
for the treatment of bone metastasis in oncologic patients.
Methods. In a prospective cohort study performed at the unit of dentistry and oral surgery
of the university of Pisa, from September 2017 until September 2018, all patients with
cancer with radiographic evidence of bone metastases and eligible for treatment with
zoledronic acid were included and followed up until September 31, 2020.
Results. Of the 300 patients, MRONJ developed in 7 (2.3%) during the 24 months of
study. Female gender (OR 4.4; 95% CI 1.8-22,1; P = .043) and statin treatment (OR 25.1;
95% CI 0.1-2822; P < 0.001) were associated with an increased risk of MRONJ.
Conclusions. In conclusion, MRONJ remains a significant risk associated with the use of
antiresorptive drugs in the setting of malignancy. Importantly, this work reinforces the
importance of a tailored program of prevention based on the evaluation of systemic and
local risk factors