**5.8 Systemic factors**

A significant risk factor for the development of MRONJ is the patient's basic disease [49]. An increased risk of medication-related osteonecrosis has been shown in women, mostly due to osteoporosis or breast cancer. A risk of MRONJ significantly increases if, in addition to antiresorptive therapy are added additional drugs that act immunosuppressively, such as chemotherapeutics or corticosteroids. Studies show that MRONJ occurs in 40% of cases in patients who have been or are still on chemotherapy, in 25% cases of patients on corticosteroid therapy and in 10% of patients with diabetes [50, 51]. Anemia, systemic lupus, hypothyroidism, renal failure, rheumatoid arthritis, hypertension and smoking are also conditions that contribute to an increased risk of osteonecrosis [52, 53].
