ArticleBone reports2026
MRONJ risk associated with combined antiresorptive and vascular endothelial growth factor receptor tyrosine kinase inhibitors.
Article in Bone reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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14 authors.
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Abstract
Background: Concomitant use of vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) and bone resorption inhibitors (BRIs) may increase the risk of medication-related osteonecrosis of the jaw (MRONJ). The relative contribution of VEGFR-TKI, BRI type, and patient-related risk factors remains unclear. Methods: We retrospectively reviewed patients treated with BRIs, with or without concomitant VEGFR-TKIs. The primary endpoint was MRONJ-free survival, defined as time from BRI initiation to MRONJ diagnosis. Secondary endpoints included MRONJ incidence and skeletal-related events (SREs). Results: Overall, 233 patients received BRI/VEGFR-TKI combination (study group) and 986 received BRI alone (control group). Median MRONJ-free survival was shorter in the study group than in controls (79 vs 202 months). However, after adjustment for smoking status, age, sex, and BRI type, concomitant VEGFR-TKI use was not independently associated with MRONJ-free survival (HR 1.3, 95% CI 0.8-2.1; Conclusion: MRONJ risk depends on BRI type and individual patient profile. VEGFR-TKIs may accelerate MRONJ onset in BP-treated patients, whereas denosumab showed higher MRONJ risk independently of VEGFR-TKI use. Treatment choices should balance MRONJ risk against skeletal disease burden.
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