Bisphosphonate-Related Osteonecrosis of the Jaws. A Severe Side Effect of Bisphosphonate Therapy

Abstract

Summary: Bisphosphonates (BP) are potent inhibitors of bone resorption used mainly in the treatment of metastatic bone disease and osteoporosis. By inhibiting bone resorption, they prevent complications as pathological fracture, pain, tumor-induced hypercalcemia. Even though patient's benefit of BP therapy is huge, various side effects may develop. Bisphosphonate-related osteonecrosis of the jaws (BRonJ) is among the most serious ones. oncologic patients receiving high doses of BP intravenously are at high risk of BRonJ development. BPs impair bone turnover leading to compromised bone healing which may result in the exposure of necrotic bone in the oral cavity frequently following tooth extraction or trauma of the oral mucosa. frank bone exposure may be complicated by secondary infection leading to osteomyelitis development with various symptoms and radiological findings. In the management of BRONJ, conservative therapy aiming to reduce the symptoms plays the main role. in patients with extensive bone involvement resective surgery may lead to complete recovery, provided that the procedure is correctly indicated. Since the treatment of BRONJ is difficult, prevention is the main goal. therefore in high risk patients dental preventive measures should be taken prior to bisphosphonate administration. this requires adequate communication between the prescribing physician, the patient and the dentist.

Promotion of Bone Formation around Alendronate-immobilized Screw-Type Titanium Implants after Implantation into Rat Molar Tooth Sockets

“…[37][38][39] Osteonecrosis can develop spontaneously after an invasive surgical procedure such as dental extraction. Janovská 40) reported that BRONJ is a result of tooth extraction in about 60% of patients. Thus, instead of systemic application, local application of BPs seems to be safer and more useful for improving the bone healing response without causing BRONJ.…”

Effect of the cumulative dose of zoledronic acid on the pathogenesis of osteonecrosis of the jaws

“…The more recent nitrogen-containing BPs, such as zolendronic acid (ZA), are the most potent inhibitors of bone resorption (13,15). ZA is an agent that is administered intravenously, and patients receiving BPs intravenously are at a high risk of developing BP-related osteonecrosis of the jaws (BRONJ) (16).…”

Experience with the treatment of bisphosphonate-related osteonecrosis of the jaw

“…This requires close cooperation between the patient, the dentist and the physician. Lack of communication could increase the risk of BRONJ development 25 . Prevention of BRONJ also includes dental care of asymptomatic patients who are already receiving bisphosphonates.…”