Conference Coverage

Preoperative Anemia Associated With MRONJ Severity and Surgical Outcomes

Edited by:
Ashton L. Stahl

Key Highlights

  • The retrospective cohort included 137 patients who underwent surgical treatment for medication-related osteonecrosis of the jaw (MRONJ).
  • Lower preoperative red blood cell (RBC) counts and hemoglobin levels were associated with Stage 3 MRONJ and outcomes classified as not improved.
  • Higher RBC counts and hemoglobin levels were associated with reduced odds of not-improved postoperative outcomes after covariate adjustment.

Lower preoperative red blood cell (RBC) counts and hemoglobin levels were associated with greater medication-related osteonecrosis of the jaw (MRONJ) severity and poorer surgical outcomes in a retrospective cohort from the University of Pennsylvania. The study is described in an abstract for the 108th American Association of Oral and Maxillofacial Surgeons Annual Meeting, Scientific Sessions and Exhibition.

The researchers reviewed records from the University of Pennsylvania’s Department of Oral and Maxillofacial Surgery between January 20, 2013, and October 31, 2023. Eligible patients had an MRONJ diagnosis, underwent surgical management, and received a complete blood count within 60 days before surgery. Investigators evaluated demographic characteristics, MRONJ stage, and surgical outcomes. Multiple logistic regression and analysis-of-variance models assessed whether preoperative RBC counts and hemoglobin levels predicted disease severity and postoperative outcomes.

Study Findings

The analysis included 137 patients with a mean age of 68.9 ± 9.8 years. Of these, 93 patients (67.9%) were female, and 44 (32.1%) were male. Stage 2 MRONJ was the most common presentation, affecting 74.5% of the cohort, followed by Stage 3 (19.7%) and Stage 1 (5.8%). Following surgery, 20 patients (14.6%) were classified as not improved.

The mean preoperative RBC count was 3.86 ± 0.629 × 10⁶/µL, and the mean hemoglobin level was 11.85 ± 1.67 g/dL. Patients with improved outcomes had higher RBC counts than those with non-improved outcomes (3.92 ± 0.60 vs 3.48 ± 0.66 × 10⁶/µL) and higher hemoglobin levels (12.00 ± 1.64 vs 11.05 ± 1.59 g/dL).

Patients with Stage 3 MRONJ had lower RBC counts than patients with Stage 1 or Stage 2 disease (3.476 ± 0.606 vs 3.95 ± 0.67 and 3.95 ± 0.60 × 10⁶/µL, respectively; P < .05). Hemoglobin levels were also lower in Stage 3 disease (10.93 ± 1.47 g/dL) than in Stage 1 (12.13 ± 1.58 g/dL) or Stage 2 MRONJ (12.09 ± 1.65 g/dL; P < .05).

After covariate adjustment, higher RBC counts were associated with a 70% reduction in the odds of a not-improved outcome (OR, 0.300; 95% CI, 0.114-0.730; P < .05). Higher hemoglobin levels were associated with a 29.7% reduction in those odds (OR, 0.713; 95% CI, 0.508-0.986; P < .05).

Clinical Implications

According to the authors, the findings support identifying preoperative anemia and optimizing patients’ hematologic status as part of surgical risk stratification. They stated that future research should determine whether correcting anemia can prevent postoperative complications.

Expert Commentary

“Presence of preoperative anemia, even to a mild extent, is associated with postoperative complications following surgical treatment of MRONJ, regardless of disease stage and patient comorbidities,” the researchers concluded.

Reference

Elder R, Fuller A, Nadella S, He P, Theken KN, Panchal NH. Does preoperative anemia influence severity of medication-related osteonecrosis of the jaw and surgical outcomes? Poster presented at: 108th American Association of Oral and Maxillofacial Surgeons Annual Meeting, Scientific Sessions and Exhibition; October 1, 2026; Seattle, WA.