Medication Related Osteonecrosis of the Jaw: 2015 Position Statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons

Abstract

Bisphosphonates are the most widely prescribed drugs for the treatment of osteoporosis, and are also used in malignant bone metastases, multiple myeloma, and Paget's disease, and provide therapeutic efficacy on those diseases. However, it was reported that occurrence of osteonecrosis of the jaw (ONJ) could be related with bisphosphonate exposures, and there have been many cases regarding this issue. Therefore, a clearer definition and treatment guidelines were needed for this disease. The American Society for Bone and Mineral Research (ASBMR) and American Association of Oral and Maxillofacial Surgeons (AAOMS) reported statements on bisphosphonate-related ONJ (BRONJ), and a revised version was recently presented. In the revised edition, the diagnosis BRONJ was changed to medication-related ONJ (MRONJ), which reflects a consideration of the fact that ONJ also occurs for denosumab, a bone resorption inhibitor of the receptor activator of nuclear factor-kappa B ligand (RANKL) antibody family, and bevacizumab, an anti-angiogenesis inhibitor. In 2009, a statement on ONJ was also reported locally by a relevant organization, which has served as basis for clinical treatment in Korea. In addition to the new official stance of the AAOMS and ASBMR, with an increasing pool of ONJ clinical experience, a revised version of the 2009 local statement is needed. As such, the Korean Society for Bone and Mineral Research (KSBMR) and the Korean Association of Oral and Maxillofacial Surgeons (KAOMS) have collectively formed a committee for the preparation of an official statement on MRONJ, and have reviewed recent local and international data to propose guidelines customized for the local Korean situation.

Bisphosphonate-related osteonecrosis of the jaw in a 66-year-old female – Case report

“…The most significant indications for BPs therapy include improving bone density in patients with osteoporosis, and reducing intraosseous development of primary malignant tumour or its metastasis. The drugs reduce hypercalcaemia in patients with primary bone tumours, such as multiple myeloma, as well as bone metastases of breast and prostate cancer [1,2,3,4,5,6].…”

“…There are many theories about the causes of osteonecrosis solely on the jaws and not in other bones. Some review articles highlight the connection with excessive suppression of the jaw bone turnover, infection, angiogenesis inhibition, soft tissue toxicity, the immune system performance and microfractures [8,3]. The half-life of bisphosphonates (BPs) in bone is very long, ranging from 1 -10 years, depending on the rate of bone turnover [8].…”

“…abscess, mucosal/gingival fistula, non-healing postextraction socket, swelling or trismus [5,4]. The disease is progressive and lasts for a long time during which the patients are treated as routine dental gingival problems resulting in deterioration of the quality of life [5,3].…”

“…intravenous (more common) or oral bisphosphonates and RANK ligand inhibitor (denosumab); -antiangiogenic agents (tyrosine kinase inhibitors and monoclonal antibody targeting VEGF) [10,11,3,4,2].…”

“…Favourable factors for necrosis is the presence of a surrounding thin mucous membrane, convexities and exostoses of the jaws. [3,12].…”