Background: We investigated osteoporosis management strategies and clinical outcomes following the occurrence of medicationrelated osteonecrosis of the jaw (MRONJ). Methods: We retrospectively studied individuals diagnosed with MRONJ during osteoporosis treatment who were managed in the Osteoporosis Center or the Oral Maxillofacial Surgery & Dental Unit at Queen Mary Hospital in Hong Kong between 2010 and 2022. We examined subsequent osteoporosis management plans, fracture events, and bone mineral density (BMD). Results: Thirty-six individuals were included (mean age, 78.5 years; 94.4% women). The estimated prevalence of MRONJ was 0.26%. All patients had been exposed to bisphosphonates, and seven had also received denosumab before MRONJ. Following MRONJ, only 14 individuals continued anti-osteoporosis treatment, a decision influenced by a higher fracture probability at MRONJ onset. The most common regimen was a teriparatide-raloxifene sequence (n=8): three patients achieved stable BMD, four achieved improving BMD, and one exhibited a mixed response. The patient with a mixed BMD response had also been treated with denosumab. Six patients sustained incident fractures after MRONJ, and these patients had lower BMD T-scores than their counterparts. Two patients experienced MRONJ recurrence, which was associated with the resumption of bisphosphonate or denosumab therapy after MRONJ. These patients had higher BMD T-scores than those who did not experience MRONJ recurrence. Conclusion MRONJ is challenging because high fracture risk necessitates discontinuation of antiresorptive agents. Teriparatide followed by raloxifene may be a reasonable regimen. Individualised decisions in osteoporosis management after MRONJ are required to balance fracture risk reduction with minimising MRONJ recurrence.

Objective:To explore the long-term efficacy of virtual reality exposure therapy (VRET) for acrophobia.Method:Sixty patients with acrophobia who visited the Nanjing Brain Hospital Affiliated to Nanjing Medical University from October 2018 to January 2021 were selected and randomly divided into VRET group ( n=30) and imaginary exposure therapy (IET) group ( n=30) using a block random number table method. The VRET group received VRET treatment, while the IET group received IET treatment. Both groups received treatment twice a week for 3 weeks. At baseline and after treatment, the acrophobia questionnaire (AQ) and attitude towards high questionnaire (ATHQ) were used to assess the patients' acrophobia symptoms, and the behavioral avoidance test (BAT) was used to assess the patients' level of avoidance when facing high altitude situations. During the 2-year follow-up after treatment, AQ and ATHQ were used to evaluate the patients' acrophobia symptoms. The repeated measures ANOVA and covariance analysis were used to analyze the data using SPSS 27.0 software. Result:(1) Repeated measures ANOVA showed that there was no significant interaction effect of AQ-anxiety, AQ-avoidance, and ATHQ scores between the two groups before and after treatment ( F=1.37, 1.95, 0.21, all P>0.05), while the time main effect of AQ-anxiety ( F=43.29) and ATHQ score ( F=13.35) was significant (both P<0.05), and the time main effect and group main effect of AQ-avoidance score were significant ( Ftime=62.84, Fgroup=5.65, both P<0.05). The AQ-avoidance scores of the VRET group(6.19±3.60, 8.25±3.80) were significantly lower than those of the IET group (9.60±3.74, 12.00±4.57)after treatment and during the follow-up period (both P<0.05).(2)After controlling for the baseline initial values of BAT in the two groups, the VRET group had a lower corrected BAT score (1.51 ± 0.72) than the IET group (4.39 ± 0.75) ( F=55.81, P<0.001), indicating that the efficacy of the VRET group was significantly better than that of the IET group. Conclusion:VRET significantly reduces acrophobia symptoms and behavioral avoidance level in patients with acrophobia, demonstrating superior efficacy compared to IET in both immediate and long-term effects.

Objective:To explore the long-term efficacy of virtual reality exposure therapy (VRET) for acrophobia.Method:Sixty patients with acrophobia who visited the Nanjing Brain Hospital Affiliated to Nanjing Medical University from October 2018 to January 2021 were selected and randomly divided into VRET group ( n=30) and imaginary exposure therapy (IET) group ( n=30) using a block random number table method. The VRET group received VRET treatment, while the IET group received IET treatment. Both groups received treatment twice a week for 3 weeks. At baseline and after treatment, the acrophobia questionnaire (AQ) and attitude towards high questionnaire (ATHQ) were used to assess the patients' acrophobia symptoms, and the behavioral avoidance test (BAT) was used to assess the patients' level of avoidance when facing high altitude situations. During the 2-year follow-up after treatment, AQ and ATHQ were used to evaluate the patients' acrophobia symptoms. The repeated measures ANOVA and covariance analysis were used to analyze the data using SPSS 27.0 software. Result:(1) Repeated measures ANOVA showed that there was no significant interaction effect of AQ-anxiety, AQ-avoidance, and ATHQ scores between the two groups before and after treatment ( F=1.37, 1.95, 0.21, all P>0.05), while the time main effect of AQ-anxiety ( F=43.29) and ATHQ score ( F=13.35) was significant (both P<0.05), and the time main effect and group main effect of AQ-avoidance score were significant ( Ftime=62.84, Fgroup=5.65, both P<0.05). The AQ-avoidance scores of the VRET group(6.19±3.60, 8.25±3.80) were significantly lower than those of the IET group (9.60±3.74, 12.00±4.57)after treatment and during the follow-up period (both P<0.05).(2)After controlling for the baseline initial values of BAT in the two groups, the VRET group had a lower corrected BAT score (1.51 ± 0.72) than the IET group (4.39 ± 0.75) ( F=55.81, P<0.001), indicating that the efficacy of the VRET group was significantly better than that of the IET group. Conclusion:VRET significantly reduces acrophobia symptoms and behavioral avoidance level in patients with acrophobia, demonstrating superior efficacy compared to IET in both immediate and long-term effects.