The status of jaw lesions and medication-related osteonecrosis of jaw in patients with multiple myeloma

J Formos Med Assoc. 2021 Nov;120(11):1967-1976. doi: 10.1016/j.jfma.2021.01.015. Epub 2021 Feb 4.


Background/purpose: Myeloma jaw lesions are not uncommon. The study aimed to investigate the status of jaw lesions and medication-related osteonecrosis of jaw (MRONJ) in multiple myeloma (MM) patients.

Methods: One hundred and twenty-two consecutive newly-diagnosed MM patients seeking dental care at a hospital of southern Taiwan was examined according to jaw lesions with complete follow-up data.

Results: Median age of the patients was 67.8 years, and 88.5% of patients were of DS stage III and 41.0% were of ISS stage III at diagnosis. Median survival was 37.9 months for 43 (35.2%) patients with jaw lesions and 57.4 months for 79 patients without jaw lesions. 1-year, 5-year and >7-year overall survival rates for patients with jaw lesions versus patients without jaw lesions were 94.9%, 67.2%, 56.7% vs 83.7%, 51.8%, 26.8% respectively. Patients with jaw lesions had the worse survival (P = 0.03). Neither age nor stage affected survival. Jaw lesions involved the mandible more often than the maxilla and stopped progressing during remission, but did not repair. Jaw lesions were the first evidence or recurrent sign of MM in six (4.9%) patients. Long-term monthly antiresorptive therapy changed the radiographic patterns of jawbones and induced MRONJ developing in 16.7% (8/48) of patients. Five (62.5%) MRONJ sites spontaneously occurred without local risk factors.

Conclusion: Nearly one-third of MM patients develop osteolytic jaw lesions that seem to be associated with poorer survival. Jaw lesion is an independent prognostic predictor of survival in myeloma. Antiresorptive drugs at less frequent dosing regimen are crucial to minimize spontaneous MRONJ.

Keywords: Jaw lesions; MRONJ; Multiple myeloma.

MeSH terms

  • Aged
  • Bisphosphonate-Associated Osteonecrosis of the Jaw* / diagnostic imaging
  • Bisphosphonate-Associated Osteonecrosis of the Jaw* / epidemiology
  • Bone Density Conservation Agents*
  • Humans
  • Multiple Myeloma* / drug therapy
  • Retrospective Studies
  • Risk Factors


  • Bone Density Conservation Agents