Low Risk MRONJ Classification — ORE Part 1 MCQ

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EasyHuman Disease & Dental ManagementLow Risk MRONJ ClassificationORE Part 1

A 55-year-old woman requires a dental extraction. She has osteoporosis and has taken oral risedronate for 3 years. She does not take systemic glucocorticoids and has no history of cancer or MRONJ. According to SDCEP, which MRONJ risk category applies?

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Correct answer: D — Low risk

The correct answer is D, low risk. SDCEP classifies a patient treated for osteoporosis with an oral bisphosphonate for less than 5 years as low risk provided they are not also taking systemic glucocorticoids. This patient has taken oral risedronate for 3 years and has no stated modifying factors. Higher risk would apply with bisphosphonate exposure beyond the 5-year medication review, concurrent systemic glucocorticoids, cancer-related anti-resorptive/anti-angiogenic treatment, or previous MRONJ. “Intermediate risk” is not an SDCEP category. “No risk” is incorrect because MRONJ risk is small, not absent, in patients taking oral bisphosphonates. The information given is sufficient, so unclassifiable risk is incorrect.

Reference: Scottish Dental Clinical Effectiveness Programme. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw, Section 3.2 and Table 3.1, 2017 guidance (extant version reviewed 2024). https://www.sdcep.org.uk/media/xtlp2uqx/sdcep-mronj-guidance-extant-2024.pdf