Oral Presentation ESA-SRB-NZSE-CaSR 2026 in conjunction with ENSA

Development of a National Multidisciplinary Consensus Statement on Medication-Related Osteonecrosis of the Jaw (MRONJ) and Osteoporosis in Australia (144878)

Christian Girgis 1 , Ying Chang 2 , Weiwen Chen 3 , Alicia Jones 4 , Albert Kim 1 , James Kim 1 , Shalinie King 1 , Michelle McDonald 5 , Ie-Wen Sim 6 , Mark Schifter 1 , Victoria Taylor 5 , Fran Milat 4
  1. Westmead Hospital, Sydney, Sydney, NSW, Australia
  2. Nepean Hospital, Sydney, NSW, Australia
  3. Wisconsin School of Medicine, Wisconsin , USA
  4. Monash Health, Melbourne, Victoria, Australia
  5. University of Sydney, Sydney, NSW
  6. University of Melbourne, Melbourne, Victoria, Australia

Medication-related osteonecrosis of the jaw (MRONJ) remains one of the most challenging and misunderstood complications associated with osteoporosis therapy. Although uncommon, fears regarding MRONJ frequently influence treatment decisions by patients, dentists and medical practitioners, and may contribute to under-treatment of osteoporosis. Prior to this project, there was no nationally endorsed Australian guidance on MRONJ.   

Healthy Bones Australia established a multidisciplinary working party including endocrinologists, dentists, oral medicine specialists, oral surgeons, oral and maxillofacial surgeons from around Australia. Over meetings from 2022 to 2025 including workshops and consensus discussions, the group reviewed current evidence and addressed key areas of uncertainty in clinical practice. We focussed on MRONJ risk assessment, invasive dental procedures in patients on osteoporosis drugs and communication between medical and dental practitioners.  Successive drafts were refined through multidisciplinary feedback and stakeholder consultation involving a number of societies including:  Australian Dental Association (ADA), the Australia and New Zealand Bone and Mineral Society (ANZBMS), the Endocrine Society of Australia (ESA), the Australian Rheumatology Association (ARA), and Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZAOMS). 

The consensus process resulted in the first nationally endorsed Australian guidance on MRONJ and osteoporosis. A traffic-light risk stratification system was developed incorporating patient- and procedure-related risk factors to classify MRONJ risk as low, intermediate or high. The statement provides pragmatic recommendations regarding patient counselling, dental assessment, procedural precautions, specialist referral pathways and ongoing osteoporosis treatment.

 As far as we are aware, this is the first sustained collaboration between endocrinology and dental experts to address MRONJ risk stratification and guidelines development. The ESA was the first of the above societies to endorse these national MRONJ guidelines. We hope this consensus statement improves communication between healthcare providers, reduces unnecessary treatment discontinuation and leads to better skeletal and oral health outcomes for Australians with osteoporosis.