MRONJ — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateMetabolic Bone DiseaseMRONJSCE Rheumatology

A 65-year-old woman receiving denosumab 60 mg every 6 months for osteoporosis undergoes a mandibular dental extraction. Nine weeks later, she has persistent jaw pain and an area of exposed mandibular bone that has not healed despite local dental care. She has never received radiotherapy to the head or neck and has no malignancy involving the jaw. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Medication-related osteonecrosis of the jaw (MRONJ)

This is medication-related osteonecrosis of the jaw (MRONJ). The discriminating findings are current denosumab exposure, a precipitating dental extraction, and exposed mandibular bone persisting for more than 8 weeks. Denosumab is a potent antiresorptive drug, and its UK SmPC recognises osteonecrosis of the jaw as a rare adverse effect, with invasive dental procedures among the risk factors. Osteomyelitis may complicate MRONJ but does not better explain this characteristic medication-associated presentation. Temporomandibular joint dysfunction does not cause exposed necrotic bone, while fibrous dysplasia is a developmental fibro-osseous disorder rather than a post-extraction complication. Osteoradionecrosis requires previous irradiation of the jaw, which is explicitly excluded.

Reference: Electronic Medicines Compendium. Prolia 60 mg solution for injection in pre-filled syringe, Summary of Product Characteristics, sections 4.4 and 4.8, updated 2026. https://www.medicines.org.uk/emc/product/568/smpc