Prevalência de osteonecrose dos maxilares associada ao uso de medicamentos anti reabsortivos: uma revisão integrativa

Abstract

Bisphosphonates (BPs) are widely used in the treatment of osteoporosis and bone metastases, acting by inhibiting bone resorption. However, their prolonged use is associated with the development of medication-related osteonecrosis of the jaw (MRONJ), particularly in oncologic patients. MRONJ is characterized by persistent bone exposure in the maxillofacial region and is associated with factors such as intravenous administration of BPs, dental extractions, and poor oral hygiene. Although its pathophysiology is not yet fully understood, hypotheses involve alterations in bone remodeling, inhibition of angiogenesis, and the presence of infections. This qualitative integrative review aimed to analyze the prevalence and risk factors of MRONJ in patients with cancer and osteoporosis undergoing treatment with antiresorptive agents. The literature search was conducted in the PubMed/MEDLINE, LILACS/BVS, and Web of Science databases using DeCS and MeSH descriptors and boolean operators. Study selection followed eligibility criteria through the reading of titles, abstracts, and full texts. The initial search yielded 75 articles, of which 14 met the inclusion criteria and were included in this review. Seven studies quantitatively assessed the prevalence of MRONJ, with rates ranging from 0% to 17.4%. Female sex was predominant in eight of the ten studies that analyzed sex distribution. The mandible was the most common site of MRONJ manifestation, followed by the maxilla. The most frequently used bisphosphonates were sodium alendronate, zoledronic acid, and minodronic acid.