Which drug class is a known contributor to medication-related osteonecrosis of the jaw (MRONJ)?

• A. Antibiotics
• B. Antidepressants
• C. Antihistamines
• D. Bisphosphonates

Answer: (D)

MRONJ happens when medications suppress the jaw’s ability to remodel and heal after injury or dental procedures. Bisphosphonates, especially potent intravenous forms used for cancer and metastatic bone disease, strongly inhibit osteoclast activity and bone turnover. The jaw remodels more rapidly than other bones, so it’s particularly vulnerable to this suppression. After dental extraction or minor trauma, the suppressed healing can lead to exposed, necrotic bone that may become infected and fail to heal. These drugs can remain bound in bone for a long time, so the risk persists long after therapy stops, explaining why this class is classically linked to MRONJ.

The other listed drug classes do not primarily impair jaw bone remodeling in a way that leads to osteonecrosis, though they have their own adverse effects.