Original Article

MRONJ and VIT D insufficiency


Background: Medication related osteonecrosis of the jaw (MRONJ) is a chronic condition of the oral cavity resulting in mucosal ulceration and exposure of underlying necrotic bone, and the ensuing secondary complications. The aim of this study was to evaluate the relationship between vitamin D deficiency and osteonecrosis of the jaw related to bisphosphonates. Materials and Methods: This was a case-control study. The samples were 20 patients taking bisphosphonates, that 10 of them were with MRONJ and 10 were non-MRONJ. Clinical examination of patients was performed to diagnose jaw osteonecrosis. Demographic data of the patients were recorded including age, sex, type of drug, duration and cause of drug intake, and measurement of serum vitamin D levels. Data were analyzed using SPSS software. Results: In the patients without MRONJ, the mean age was 60.60 (±14.975) years, and in the patients with MRONJ, the mean age was 68.30 (69.92) years. As a whole, of the 16 female patients in this study, 10 cases (62.5%) were non- MRONJ and 6 cases (37.5%) were suffered by MRONJ. All of the male patients presented with MRONJ. In control group mean of vitamin D was 63.990 ng/ ml (±29.796) and in case group mean of vitamin D was 29.510 ng/ml (±23.723). The serum level of vitamin D (25-OHD) was significantly higher in control group than in the case group (p=0.010). Conclusion: According to our result, there were statistically significant relationship between age, sex, type of drug, vitamin D level, and MRONJ (p>0.05). Key words: MRONJ; Vitamin D; Bisphosphonates; Osteonecrosis of the jaws.
1. Moradzadeh K, Larijani B, Keshtkar A, Hossein Nezhad A, Rajabian R, Nabipoor I, et al. Normal values of Vitamin D and prevalence of Vitamin D deficiency among Iranian population. SJKU. 2006; 10 (4): 22-42.

2. Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: when to test and how to treat. Mayo Clin Proc. 2010; 85 (8): 752-7; quiz 7-8.

3. Tabrizi R, Moosazadeh M, Akbari M, Dabbaghmanesh MH, Mohamadkhani M, Asemi Z, et al. High Prevalence of Vitamin D Deficiency among Iranian Population: A Systematic Review and Meta-Analysis. Iran J Med Sci. 2018; 43 (2): 125-39.

4. Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014; 144 Pt A: 138-45.

5. George EL, Lin Y-L, Saunders MM. Bisphosphonate-related osteonecrosis of the jaw: a mechanobiology perspective. Bone reports. 2018; 8: 104-9.

6. Reginster J-Y, Burlet N. Osteoporosis: a still increasing prevalence. Bone. 2006; 38 (2): 4-9.

7. Zara S, De Colli M, Di Giacomo V, Zizzari VL, Di Nisio C, Di Tore U, et al. Zoledronic acid at subtoxic dose extends osteoblastic stage span of primary human osteoblasts. Clin Oral Investig. 2015; 19 (3): 601-11.

8. Russell RGG. Bisphosphonates: the first 40 years. Bone. 2011; 49 (1): 2-19.

9. Drake MT, Clarke BL, Khosla S, editors. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clinic Proceedings; 2008: Elsevier.

10. Zafar S, Coates DE, Cullinan MP, Drummond BK, Milne T, Seymour GJ. Effects of zoledronic acid and geranylgeraniol on the cellular behaviour and gene expression of primary human alveolar osteoblasts. Clin Oral Investig. 2016; 20 (8): 2023-35.

11. Vohra F, Al-Rifaiy MQ, Almas K, Javed F. Efficacy of systemic bisphosphonate delivery on osseointegration of implants under osteoporotic conditions: lessons from animal studies. Arch Oral Biol. 2014; 59 (9): 912-20.

12. Miloro M, Ghali G, Larsen P, Peterson LJ, Waite P. Peterson's principles of oral and maxillofacial surgery. 3 ed.: PMPH-USA; 2019. p:

13. Krimmel M, Ripperger J, Hairass M, Hoefert S, Kluba S, Reinert S. Does dental and oral health influence the development and course of bisphosphonate-related osteonecrosis of the jaws (BRONJ)? J Oral Maxillofac Surg. 2014; 18 (2): 213-8.

14. Taylor T, Bryant C, Popat S. A study of 225 patients on bisphosphonates presenting to the bisphosphonate clinic at King's College Hospital. Br Dent J. 2013; 214 (7): E18.

15. Nisi M, La Ferla F, Karapetsa D, Gennai S, Miccoli M, Baggiani A, et al. Risk factors influencing BRONJ staging in patients receiving intravenous bisphosphonates: a multivariate analysis. Int J Oral Maxillofac Surg. 2015; 44 (5): 586-91.

16. Fliefel R, Troltzsch M, Kuhnisch J, Ehrenfeld M, Otto S. Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review. Int J Oral Maxillofac Surg. 2015; 44 (5): 568-85.

17. Jung SY, Suh HS, Park JW, Kwon JW. Drug holiday patterns and bisphosphonate-related osteonecrosis of the jaw. Oral Dis. 2018.
IssueVol 8, No 1 (Winter 2021) QRcode
SectionOriginal Article(s)
MRONJ; Vitamin D; Bisphosphonates; Osteonecrosis of the jaws.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Shirani G, Tonkaboni A, Mazani M, Mirzashahi B, Garcia Garcia A, Kharazifard MJ. MRONJ and VIT D insufficiency. J Craniomaxillofac Res. 8(1):11-15.