ASSOCIATION BETWEEN VITAMIN D DEFICIENCY AND DRUG-RELATED OSTEONECROSIS OF THE JAW: A SYSTEMATIC REVIEW

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive and antiangiogenic agent therapy. Vitamin D plays a crucial role in modulating bone metabolism and the immune response through the RANKL/OPG signaling axis. Its deficiency can alter bone turnover and significantly impair the mucosal barrier and healing process. Objective: To evaluate the association between vitamin D deficiency and the risk of development or severity of medication-related osteonecrosis of the jaw (MRONJ). Methodology: A systematic literature review was conducted in the PubMed, Google Scholar, Web of Science, and BVS LILACS, in accordance with the PRISMA guidelines. Studies assessing the serum levels of 25-hydroxyvitamin D [25(OH)D] in patients undergoing drug therapy at risk for MRONJ were included. Results: The initial search identified 362 records, of which 9 studies were included in the qualitative synthesis. Evidence demonstrates that patients with serum vitamin D levels below 30 µg/L show greater susceptibility to post-extraction healing failures. Vitamin D deficiency has been shown to act as an independent factor in delayed tissue repair and the exacerbation of local infectious processes in patients using bisphosphonates and denosumab, being classified in the current literature as a potent contextual modifier of the disease course. Conclusion: Hypovitaminosis D acts as a risk factor and a negative modifier of the clinical prognosis of MRONJ. Screening for serum 25(OH)D levels and prophylactic supplementation emerge as recommended interventions to mitigate the risks of this complication, especially prior to invasive dental surgical procedures.