Jaw osteonecrosis related to bisphosphonate therapy

High prevalence of early-onset osteopenia/osteoporosis after allogeneic stem cell transplantation and improvement after bisphosphonate therapy

“…41 In addition, we did not observe any cases of osteonecrosis of the jaw in our patients after the bisphosphonate treatment, which has been described previously. [42][43][44] This may be due to the relatively small number of bisphosphonate-treated patients in our study or to other factors such as the association of extended intravenous bisphosphonate therapy with osteonecrosis.…”

Bisphosphonate-related Osteonecrosis of the Jaws: An Update on Clinical, Pathological and Management Aspects

“…The duration of bisphosphonate therapy is also an important factor which relates to the likelihood of developing BRONJ. In addition, the more potent nitrogen-containing bisphosphonates, such as pamidronate and zolendronate, are more often associated with the development of BRONJ than the oral bisphosphonate formulations [16][17][18][19][20][21][22][23][24][25]. An important paper published recently by Corso et al [44] has highlighted the importance of reducing the schedule of zolendronic acid in order to lower the risk of BRONJ in patients with multiple myeloma.…”

“…Special stains such as PAS and Gram staining can be useful to further confirm the findings. Several authors have found a striking high presence of Actinomyces in necrotic bone areas and considered these pathogens to be involved in the chronic, non-healing process of BRONJ [12,19,25,31,42]. It should be noted that Actinomyces are commonly present as commensals in the oral cavity thus their presence within the necrotic lesions is likely not an etiological factor in the pathogenesis of BRONJ, but rather a secondary infection of the necrotic tissues [31,46].…”

“…Microbiological investigations have detected a variety of oral pathogens such as Actinomyces, Enterococcus, Candida albicans, Haemophilus influenza, alpha-haemolytic streptococci, Lactobacillus, Enterobacter and Klebsiella pneumoniae, etc. [25]. However, it is important to stress that cultures taken from an open sinus tract or exposed jaw bone may give misleading results because the isolates may include non-pathogenic microorganisms that are colonizing the site [50].…”

“…All the initial observations have pointed to the potential role of the intravenously administered bisphosphonates such as pamidronate and zoledronate. Additionally, BRONJ has been reported in a small number of patients (until now about 50 cases) who had received oral non-nitrogen or oral nitrogen-containing bisphosphonates for both cancer and non-cancerous conditions [6,11,17,[25][26][27][28][29][30]. Recently, Yarom et al [31] have reported 11 cases of BRONJ induced by oral bisphosphonates.…”