Visualization analysis of literature on medication-related osteonecrosis of the jaw

Abstract

BACKGROUND: Bibliometric and visualization analyses of theme-related literature on medication-related osteonecrosis of the jaw are essential for gaining a comprehensive understanding of its research foundation and emerging trends. OBJECTIVE: To reveal research hotspots, current status, and trends in medication-related osteonecrosis of the jaw through bibliometrics, citation analysis, and visualization analysis. METHODS: The top 100 most-cited medication-related osteonecrosis of the jaw research articles published between 2004 and 2024 were retrieved and screened from the Web of Science Core Collection (SCI-Expanded). A bibliometric analysis was conducted to extract and analyze core characteristics such as annual publication volume, countries, institutions, authors, journal sources, and co-citation relationships, followed by the use of CiteSpace 6.4.R1 software to generate knowledge maps, thereby identifying research hotspots and emerging trends. RESULTS AND CONCLUSION: The included literature accumulated a total of 12 337 citations, with an average annual citation frequency of 6.17 per article. The international core collaboration network was stable and close, with the United States, University of London, and Professor Salvatore L. Ruggiero ranking first in high-cited paper output among countries, research institutions, and authors, respectively. Hot keywords mainly included risk factors, bisphosphonates, cancer, and osteoclasts; the burst keyword was predominantly 'Denosumab', and research directions were diversified. The research heat on medication-related osteonecrosis of the jaw generally showed an upward trend, with core focus on pathological mechanisms, risk factors, and treatment strategies. High-level evidence, such as large cohort studies (LOE 2a), high-quality randomized controlled trials (LOE 1b), GRADE systematic reviews and meta-analyses, and clinical practice guidelines, significantly promoted the field's development. Looking forward, tissue engineering and regenerative medicine, including 3D-printed scaffolds, stem cell therapy, novel biomaterials, and in vitro models, are expected to provide breakthrough strategies for bone repair, regeneration, and mechanistic research of medication-related osteonecrosis of the jaw.

1. Introduction

Medication-related osteonecrosis of the jaw (MRONJ) is a metabolic disorder and necrotic disease of the jawbone caused by antiresorptive or antiangiogenic medications, commonly occurring in patients with bone metastases from malignant tumors and osteoporosis [1]. The condition was first systematically reported by Marx in 2003, establishing a direct causal relationship between intravenous zoledronic acid and jaw necrosis [2], after which case reports of bisphosphonate-related osteonecrosis of the jaw significantly increased. As the spectrum of causative drugs expanded, the American Association of Oral and Maxillofacial Surgeons officially revised the disease name to medication-related osteonecrosis of the jaw in 2014 to reflect its multi-drug etiology [3]; the 2022 updated guidelines further integrated advances in bone immunomicroenvironment imbalance mechanisms and bioactive barrier materials for guided bone regeneration, providing a theoretical framework for multidisciplinary collaborative diagnosis and treatment [4]. Against the backdrop of accelerated population aging in China, the high incidence of osteoporosis and malignant tumors has led to a significant increase in the clinical use of bisphosphonates, resulting in a surge in the incidence of MRONJ [5-7]. However, limited awareness among healthcare providers and patients exacerbates the contradiction between high disease risk and low prevention awareness [8-9], posing greater challenges to the prevention and treatment of MRONJ.

In recent years, significant progress has been made in the field of MRONJ research, with scientific literature growing exponentially and the disciplinary knowledge system continuously updated [1,3,10]. Scientific literature, as nodes in the knowledge network, does not exist in isolation but rather forms an interconnected and dynamically evolving knowledge system. Citation relationships among literature reflect the historical development of the discipline and reveal future research directions. In this context, bibliometric and visualization analyses based on high-impact literature have become key tools for dissecting the research foundation and frontier dynamics of MRONJ. CiteSpace software presents potential patterns in literature through knowledge mapping, and its co-citation analysis function can precisely locate core knowledge nodes driving disciplinary evolution. Currently, no bibliometric study on MRONJ has been reported in the China National Knowledge Infrastructure (CNKI) database. Although BAYRAM et al. [11] have conducted a bibliometric analysis based on the Web of Science, their study did not focus on the top 100 most-cited articles, which are crucial for understanding the field's foundational knowledge and evolution.