Diabetes as a Risk Factor for Medication-Related Osteonecrosis of the Jaw

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a severe devastating complication for which the exact pathogenesis is not completely understood. Multiple systemic and local factors may contribute to the development of MRONJ. A growing body of evidence supports diabetes mellitus (DM) as an important risk factor for this complication; however, the exact mechanism by which DM may promote MRONJ has yet to be determined. The current review elucidates the role of DM in the pathogenesis of MRONJ and the mechanisms by which DM may increase the risk for MRONJ. Factors related to DM pathogenesis and treatment may contribute to poor bone quality through multiple damaged pathways, including microvascular ischemia, endothelial cell dysfunction, reduced remodeling of bone, and increased apoptosis of osteoblasts and osteocytes. In addition, DM induces changes in immune cell function and promotes inflammation. This increases the risk for chronic infection in the settings of cancer and its treatment, as well as antiresorptive medication exposure, thus raising the risk of developing MRONJ. A genetic predisposition for MRONJ, coupled with CYP 450 gene alterations, has been suggested to affect the degradation of medications for DM such as thiazolidinediones and may further increase the risk for MRONJ.

Impaired Bone Regenerative Effect of Exosomes Derived from Bone Marrow Mesenchymal Stem Cells in Type 1 Diabetes

“…However, our results reveal that for patients with diabetes mellitus, the autologous transplantation of BMSC‐exos to promote bone regeneration may be inadequate because the bone regenerative potential of those BMSC‐exos is compromised. Considering that patients with diabetes mellitus themselves are more susceptible to impaired bone healing and osteonecrosis , there is a compelling need to develop bone reparative strategies specifically targeting the population of patients with diabetes mellitus. Therefore, our findings are of great significance for the future clinical translation of BMSC‐exos‐based therapies.…”

Hyperbaric oxygen therapy and osteonecrosis

“…Alveolar trauma after dental surgery, intubation, and denture impressions are reported as precipitators of BRONJ (Marx et al , ) (Ruggiero et al , ; Yazdi and Schiodt, ). Diabetes is an identifiable risk factor (Molcho et al , ; Peer and Khamaisi, ), and other comorbidities include age, anemia, history of steroid use, and other dental diseases (Khan et al , ; Kim et al , ). A delay in the time from exposure to bisphosphonate to clinical manifestation of disease is often noted (Migliorati, ; Ruggiero et al , ; Marx et al , ).…”

A gyógyszer okozta állcsontnekrózis prognózisát befolyásoló faktorok

“…Így az általunk észlelt statisztikai összefüggésért nem az aktuálisan mért magasabb vércukorérték és annak a másodlagos fertőzésveszélyt növelő hatása tehető felelőssé. A diabetes mellitus feltehetően az általa létrehozott elváltozásokon keresztül -úgymint microvascularis ischaemia, endothelsejt-diszfunkció, csökkent osteoblast-és osteoclastfunkció, valamint csökkent remodelling -vezethet a rosszabb prognózishoz [31,32].…”