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Osteoradionecrosis (ORN) primarily occurs as a result of bone degradation due to radiation exposure. When patients undergo radiotherapy, especially for head and neck cancers, the radiation can damage the local blood supply to the bones, particularly the mandible. This compromised blood flow leads to reduced healing capabilities, and the bone may become necrotic, particularly if trauma or infection occurs in the irradiated area. The underlying processes involve a combination of direct cellular damage from radiation and indirect effects such as fibrosis and vascular compromise, ultimately resulting in necrosis of the bone.

In contrast, while bone infections can be a consequence of compromised bone health in ORN patients, they are not the underlying cause of the condition itself. Similarly, genetic factors and dietary deficiencies can contribute to overall bone health but do not specifically lead to osteoradionecrosis inherently. The primary focus of ORN is the damage associated with radiation therapy, making bone degradation due to radiation exposure the leading cause of this condition.