Combined Administration of Bisphosphonates, Chemotherapeutic Agents, and/or Targeted Drugs Increases the Risk for Stage 3 Medication-Related Osteonecrosis of the Jaw: A 4-Year Retrospective Study

Table 1

2019 MASCC/ISOO/ASCO staging system for MRONJ.

At risk	No symptoms and signs in patients who have been administered bone-modifying agents
Increased risk	No necrotic bone or fistulas that probe to bone but nonspecific symptoms, signs, and radiographic changes
Stage 1	Exposed and necrotic bone or fistulas that probe to bone in patients who are asymptomatic without evidence of infection
Stage 2	Exposed and necrotic bone or fistulas that probe to bone in patients who are symptomatic with or without purulent drainage
Stage 3	Exposed and necrotic bone or fistulas that probe to bone in patients who are symptomatic with infection, and one or more of the following: exposed and necrotic bone extending beyond the region of alveolar bone (i.e., inferior border and ramus in the mandible, maxillary sinus, and zygoma in the maxilla) resulting in pathologic fracture, extraoral fistula, oral antral/oral nasal communication, or osteolysis extending to the inferior border of the mandible of sinus floor

Abbreviations: MASCC/ISOO/ASCO: Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology/American Society of Clinical Oncology; MRONJ: medication-related osteonecrosis of the jaw.