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Pathology

(63) Does Preoperative Albumin Predict MRONJ Severity and Surgical Outcomes?

Thursday, September 18, 2025
2:30 PM - 4:00 PM EDT

    Poster Presenter(s)

  • Adam Fuller, BA

    Student
    University of Pennsylvania
    Santa Barbara, California, United States

    • Co-Author(s)

  • Srighana Nadella, BA (she/her/hers)

    Student
    University of Pennsylvania
    Philadelphia, Pennsylvania, United States

  • GH

    Georgios Hatzipetrou, DMD

    Resident
    University of Pennsylvania
    Philadelphia, Pennsylvania, United States

  • PH

    Puhan He, MD, DMD

    Resident/Future Assistant Professor
    University of Pennsylvania
    Philadelphia, Pennsylvania, United States

  • Kathrine N. Theken, Pharm D, PhD (she/her/hers)

    Assistant Professor, Department of Oral and Maxillofacial Surgery and Pharmacology, School of Dental
    University of Pennsylvania
    Philadelphia, Pennsylvania, United States

  • Neeraj H. Panchal, DDS, MD, MA

    Assistant Professor
    Department of Oral and Maxillofacial Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA
    Philadelphia, Pennsylvania, United States

Disclosure(s):
Adam Fuller, BA: No financial relationships to disclose
Abstract:

Purpose: Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating condition associated with antiresorptive and antiangiogenic therapy. While various risk factors have been identified, the effect of nutritional status on MRONJ surgical outcomes is unclear. Nutritional status can be determined by metrics such as body mass index (BMI) and serum albumin levels. This study evaluates the impact of preoperative albumin levels and BMI on MRONJ staging and surgical outcomes.

Methods: A retrospective cohort study was conducted by reviewing patient records from the University of Pennsylvania’s Oral and Maxillofacial Surgery Department between 2013 and 2022. Patients diagnosed with MRONJ who underwent surgical management and had preoperative albumin levels measured within 3 months or 1 month prior to surgery were included. BMI, demographic factors, MRONJ stage, and surgical outcomes were analyzed. Multiple logistic regression and ANOVA models assessed the predictive value of albumin and BMI on MRONJ severity and postoperative outcomes

Results: Of the full cohort, 95 patients had albumin measurements within 3 months before surgery and 70 patients had albumin measurements within 1 month before surgery. In the 3-month cohort, serum albumin levels were significantly lower in patients with Stage 3 MRONJ (3.55 ± 0.612 g/dl) compared to patients with Stage 1 (4.06 ± 0.467g/dl; P < .05) and Stage 2 (3.89 ± 0.355g/dl; P < .05). A similar relationship was observed in the 1-month cohort. Preoperative albumin levels were inversely associated with poor surgical outcomes, with an odds ratio (95% confidence interval) of 0.112 (0.0188-0.494) in the 3-month cohort and 0.163 (0.0272-0.743) in the 1-month cohort. In contrast, BMI was not associated with MRONJ severity or surgical outcomes.

Conclusion: Preoperative albumin levels serve as a strong predictor of MRONJ severity and surgical outcomes, emphasizing the importance of nutritional assessment in perioperative planning. BMI was not a significant predictor, emphasizing the need to assess specific biochemical markers rather than relying solely on anthropometric measures. Future research should explore whether preoperative nutritional interventions can improve MRONJ surgical outcomes.
MRONJ Stage and Albumin LevelsOutcomes and Albumin Levels