Bisphosphonate Associated Osteonecrosis of the Jaw

Abstract

In 2003, the first reports describing osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BP) were published. These cases occurred in patients with cancer receiving high-dose intravenous BP; however, 5% of the cases were in patients with osteoporosis receiving low-dose bisphosphonate therapy. We present the results of a systematic review of the incidence, risk factors, diagnosis, prevention, and treatment of BP associated ONJ. We conducted a comprehensive literature search for relevant studies on BP associated ONJ in oncology and osteoporosis patients published before February 2008.All selected relevant articles were sorted by area of focus. Data for each area were abstracted by 2 independent reviewers. The results showed that the diagnosis is made clinically. Prospective data evaluating the incidence and etiologic factors are very limited. In oncology patients receiving high-dose intravenous BP, ONJ appears to be dependent on the dose and duration of therapy, with an estimated incidence of 1%–12% at 36 months of exposure. In osteoporosis patients, it is rare, with an estimated incidence < 1 case per 100,000 person-years of exposure. The incidence of ONJ in the general population is not known. Currently, there is insufficient evidence to confirm a causal link between low-dose BP use in the osteoporosis patient population and ONJ. We concluded BP associated ONJ is associated with high-dose BP therapy primarily in the oncology patient population. Prevention and treatment strategies are currently based on expert opinion and focus on maintaining good oral hygiene and conservative surgical intervention.

A Comparative Study of Use of Zoledronic Acid and Teriparatide in Postmenopausal Osteoporosis

“…Osteonecrosis of the jaw is a rare adverse effect of zoledronic acid treatment which appears to occur more frequently with IV biphosphonates. 2 The majority of the reported cases were also receiving chemotherapy or corticosteroids. Length of exposure seems to be the most important risk factor for this adverse event and caution is required for use of biphosphonates beyond 2 years.…”

“…Osteoporosis is most prevalent in women over the age of 50 as the hormonal influence of estrogen on bone health original article 1,3 Assistant Professor, 2 Associate Professor dissipates with the onset of menopause. The progressive changes in bone structure, quality and density lead to pathological fractures and an increase in morbidity and mortality among menopausal women while a perfect treatment has yet to be discovered to completely cure this progressive disease many breakthroughs have been made in order to prevent fractures and improve quality of life.…”

Intérêt de l’oxygénothérapie hyperbare dans la prévention et le traitement des ostéonécroses des maxillaires dues aux bisphosphonates

“…Dans l'ostéoporose et la maladie de Paget, l'incidence des ONM sous BP per os est très mal connue. Toutefois, quelques publications mentionnent que le risque de survenue d'une ONM est bien plus faible que celui observé chez les patients traités par BP IV pour une pathologie maligne et serait estimée à 1 cas pour 10 000 à 100 000 patient-années [8,16,17].…”

Osteonecrosis de los maxilares por bisfosfonatos: Actualización y puesta al día

“…Khan y col 36 señalan una incidencia entre el 1 y el 12% para pacientes en tratamiento con bisfosfonatos intravenosos, similar a la señalada por Ruggiero y col 12 en el consenso actualizado de la Asociación Americana de Cirujanos Orales y Maxilofaciales, que postulan entre 0,8 y 12% para estos pacientes.…”