MRONJ Corticosteroid Risk — ORE Part 1 MCQ

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ModerateHuman Disease & Dental ManagementMRONJ Corticosteroid RiskORE Part 1

A 65-year-old patient has taken oral alendronate for osteoporosis for 4 years. They also take oral prednisolone 7.5 mg daily for polymyalgia rheumatica and require a tooth extraction. According to SDCEP guidance, which MRONJ risk category applies?

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Reveal the answer and explanation

Correct answer: D — Higher risk because systemic glucocorticoids are co-prescribed

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

The correct answer is A. SDCEP defines low risk for oral bisphosphonate treatment of less than 5 years only where the patient is not concurrently receiving systemic glucocorticoids. This patient takes daily oral prednisolone, so they are higher risk despite only 4 years of alendronate use. B applies the duration criterion but overlooks its glucocorticoid exclusion. E is incorrect because concurrent systemic glucocorticoids confer higher-risk classification at any bisphosphonate duration, not only after 5 years. C is incorrect because osteoporosis treatment carries a small but recognised MRONJ risk, and D is incorrect because the medication history is sufficient for classification.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), Dental Companion, Prevention of Medication-Related Osteonecrosis of the Jaw: “Risk categories”, 2026. https://companion.sdcep.org.uk/prevention-of-medication-related-osteonecrosis-of-the-jaw/assessing-patient-risk/risk-categories/