MRONJ Risk — ORE Part 1 MCQ

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ModerateHuman Disease & Dental ManagementMRONJ RiskORE Part 1

A 65-year-old woman has been taking oral alendronic acid for osteoporosis for 3 years. She requires extraction of a lower molar. According to SDCEP guidance, what is her MRONJ risk category?

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Correct answer: C — Low risk

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as E

SDCEP guidance categorises MRONJ risk into 'low risk' and 'higher risk' based on underlying medical condition, drug type, duration, and route. For oral bisphosphonates in osteoporosis (as opposed to cancer where IV bisphosphonates or high-dose therapy confer 'higher risk'), patients are classified as 'low risk' even when requiring bone-impacting procedures such as extraction. This patient is 3 years into therapy with no documented complicating factors, placing her firmly in the low risk category. Option B (higher risk) would apply to cancer patients or those >5 years into oral therapy after medication review. Options C and E use non-standard SDCEP terminology. Option D (no risk) contradicts SDCEP's acknowledgement of increased risk in this population.

Reference: SDCEP (Scottish Dental Clinical Effectiveness Programme). Oral Health Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw (MRONJ) - Guidance in Brief (extant 2024) and supplementary patient information. https://www.sdcep.org.uk/published-guidance/medication-related-osteonecrosis-of-the-jaw/