Bisphosphonates and Osteonecrosis of the Jaws: A Review of Clinical Features and the Drug Effect on Oral Soft Tissues

Abstract

The beneficial effects of the nitrogen-containing bisphosphonate drugs have been clearly defined, especially for the treatment for osteoporosis, metastatic or primary bone malignancies, and some rare bone diseases. The adverse effects of these drugs on oral hard and soft tissues are significant and recognized with increasing frequency. The clinical, radiographic, and histopathologic features of osteonecrosis of the jaws (ONJ) are well characterized; the effects of bisphosphonates on oral soft tissues are an emerging area of study. This review will provide an overview of ONJ from a clinical perspective and also discuss recent findings related to bisphosphonateinduced soft tissue pathology.

“Bisphosphonates: Possible Modes of Action and Implications for Dental Implant Treatment. A Review of the Literature”

“…The histopathological specimens obtained from patients that have been affected by BRONJ appears to be consistent among studies [37,[154][155][156][157][158][159][160].…”

A Rare Case of Epidermoid Carcinoma on Mandibular Osteonecrosis Due to Oral Bisphosphonates in the Treatment of Osteoporosis. Case Report and Review of Literature

“…Its mechanism of action is manifold, with recent published studies recognizing: inhibition of osteoclastic bone resorption, induction of osteoblasts to the secretion of an osteoclastmediated inhibition of bone formation, induction of apoptosis in osteoclast ("programmed cell death"), an antiangiogenic effect that reduces endothelial growth factor (EFG). Also, associated with the previous ones, there is an alteration of the macrophages and the cicatrization of the oral mucosa by involvement of the fibroblasts and keratinocytes [2].…”