Awareness, Prescribing Practices and Perceived Roles of Medical Practitioners in the Effects of Bisphosphonates on Oral Health

Background: Bisphosphonates are widely prescribed as antiresorptive agents for osteoporosis, Paget’s disease, and malignancies with bone metastases. While effective in reducing skeletal-related events, they are linked to medication-related osteonecrosis of the jaw (MRONJ), a serious but preventable complication that impairs quality of life. As medical practitioners initiate bisphosphonate therapy, their awareness and collaboration with dental professionals are crucial. However, in Malaysia, limited data exist on the level of awareness, practices and role among medical practitioners regarding MRONJ. Objectives: This study assessed the awareness, prescribing practices, and perceived roles of medical practitioners at a university hospital concerning oral health risks associated with bisphosphonate therapy. Method: A cross-sectional survey using a validated questionnaire was conducted at the Universiti Malaya Medical Centre. The participants included medical officers; Clinical Master’s degree trainees; and specialists in primary care, orthopedics, and medicine. The questionnaire evaluated demographics, awareness, prescribing patterns, referral behaviors, and patient education roles. A total of 130 responses were analysed via descriptive statistics and chi-square tests. Results: Overall, 96.2% of the respondents were aware of bisphosphonate complications, with 94.6% correctly identifying MRONJ. However, only 58.5% knew of relevant guidelines, and only 23.8% felt adequately informed. In practice, 73.8% educated patients about MRONJ, 49.2% advised pretreatment dental evaluation, and 52.3% referred patients for dental screening. Additionally, 63.1% advised patients to inform their dentist if they received bisphosphonates. Conclusion: Although practitioners were highly aware of MRONJ, preventive practices such as dental referrals and consistent patient education were limited. These findings highlight the need for enhanced training, better dissemination of guidelines, and structured referral systems. Stronger interdisciplinary collaboration is essential to reduce MRONJ incidence and improve patient safety.