Clinicopathological Correlations in Medication-Related Osteonecrosis of the Jaw: A Retrospective Histopathological Study

37th European Congress of Pathology, Vienna, Avusturya, 6 - 10 Eylül 2025, ss.102, (Özet Bildiri)

Background & Objectives: Medication-related osteonecrosis of the

jaw (MRONJ) is a severe complication associated with antiresorptive

and antiangiogenic therapies, particularly in patients with malignancies.

Histopathological features of MRONJ remain underexplored and

unstandardized, limiting their clinical utility. This study aimed to investigate

the correlation between clinical variables and histopathological

parameters in MRONJ cases to identify potential prognostic indicators.

Methods: Among 101 MRONJ cases diagnosed between 2013 and

2025 and archived in the Department of Oral Pathology at Gazi University,

32 cases associated with malignancy-related medication use were

retrospectively selected. Demographic, clinical, and radiographic data

were recorded. Variables such as soft tissue changes, inflammation,

haemorrhage, presence of microorganisms, bone resorption, proportion

of viable bone, cement line integrity, and presence of osteoclasts

were assessed. Histochemical stains were applied to further characterize

microorganisms. Statistical analyses were performed to assess correlations

between clinical and histopathological findings.

Results: The most frequent clinical trigger was tooth extraction, and

the most commonly used drug was zoledronic acid. All cases showed

classic features of osteonecrosis; Actinomyces was detected in 62.5%

of cases. Inflammation was higher in male patients (p < 0.0001),

those with metastases (p < 0.0001), and following tooth extraction

(p < 0.0001). Denosumab use was linked to increased inflammation

(p = 0.0008) and osteoclast activity (p = 0.0287) compared to zoledronic

acid. Actinomyces presence correlated with metastasis, tooth extraction, and inflammation (p < 0.05). The type of primary tumour

and treatment regimen significantly influenced bone vitality and inflammatory

response. Notably, age was the only variable significantly correlated

with all histopathological parameters, suggesting a potential

role of advanced age in disease severity.

Conclusion: Histopathological findings in MRONJ correlate with key

clinical variables. Age, drug type, metastasis, and local risk factors

may influence disease severity. These findings support the potential

prognostic value of histopathology and underscore the need for standardized

evaluation criteria in MRONJ.