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Oral Bisphosphonate Low Risk — MFDS Part 1 MCQ

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ModerateHuman DiseaseOral Bisphosphonate Low RiskMFDS Part 1

A patient has taken oral alendronate for osteoporosis for 2 years. They have no history of MRONJ, are not taking systemic glucocorticoids and require a straightforward dental extraction. What is the most appropriate management?

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Correct answer: D — Proceed with the extraction in primary care without altering alendronate solely for the procedure

This patient is at low risk of MRONJ because alendronate is being used for osteoporosis, exposure is under 5 years and there is no concurrent systemic glucocorticoid treatment. SDCEP recommends performing straightforward extractions in primary care after discussing the small MRONJ risk and obtaining valid consent. Alendronate should not be stopped solely for the extraction because discontinuation has not been shown to reduce MRONJ risk. Treatment should not be deferred, and antiresorptive use alone does not require secondary-care referral. Antibiotic or antiseptic prophylaxis should not be prescribed specifically to prevent MRONJ unless there is another clinical indication. Healing should be reviewed; suspected MRONJ associated with failure to heal at 8 weeks warrants specialist referral.

Reference: Scottish Dental Clinical Effectiveness Programme. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw, sections 3 and 4.2. Published 2017; reviewed and extant March 2024. https://www.sdcep.org.uk/media/xtlp2uqx/sdcep-mronj-guidance-extant-2024.pdf