Medication-Related Osteonecrosis of the Jaw: An Evidence-Based 2025 Position Statement from a Korean Multidisciplinary Task Force

Abstract

With a rapidly aging population and increasing use of antiresorptive agents, medication-related osteonecrosis of the jaw (MRONJ)represents a growing clinical challenge worldwide. To address the need for tailored clinical guidance, a multidisciplinary task forcewas convened. Five Korean academic societies—the Korean Society for Bone and Mineral Research, the Korean Association ofOral and Maxillofacial Surgeons, the Korean Society of Maxillofacial Plastic and Reconstructive Surgeons, the Korean OsteoporosisSociety, and the Korean Endocrine Society—collaborated to develop this position statement. The consensus was formulated throughcomprehensive reviews of literature, combined with three rounds of formal surveys to consolidate expert opinion on controversialtopics. This position paper provides evidence-based clinical guidelines for the prevention, diagnosis, and management of MRONJtailored to the Korean healthcare environment. The diagnostic criteria affirm the standard definition but add a provision for diagnosisbased on clinical or radiographic evidence of necrotic bone, even if the traditional 8-week timeframe has not been met. The committee advocates for retaining stage 0 in the staging system to emphasize early detection and preventive intervention. Key recommendations include prescriptive, drug-specific guidelines for prophylactic drug holidays (e.g., a 2-month pause for oral bisphosphonates;timing surgery 3 to 4 months after the last denosumab injection) to minimize MRONJ risk from dental procedures. This statementalso provides a clear framework for therapeutic drug holidays in established MRONJ, carefully balancing the need for jaw healingagainst systemic fracture risk. For treatment, this statement advocates for early and active surgical intervention across all MRONJstages, supported by evidence of superior long-term outcomes compared to conservative management. This position statement offersa unique, evidence-based Korean clinical practice guideline for managing MRONJ. It is intended to standardize care, reduce clinicalconfusion, and ultimately improve patient outcomes by providing a clear framework for decision-making.