Oral Bisphosphonate-Related Osteonecrosis of the Jaw: Incidence, Clinical Features, Prevention, and Treatment Recommendations

Abstract

Biphosphonate-related osteonecrosis of the jaw (BRONJ) is a devastating side effect of oral bisphosphonates associated with patient morbidity and high financial burden to health services. BRONJ is usually associated with parenteral use of bisphosphonates in oncologic patients, but its incidence among individuals with osteoporosis who take oral bisphosphonates is on the rise. In the absence of definitive treatment for BRONJ, every effort should be made toward its prevention. The patients must be informed about the extremely small but proven risk of oral BRONJ and be recommended to undergo periodic dental evaluation and meticulous oral hygiene. Once BRONJ occurs, long-term antibiotic therapy and superficial curettage may be beneficial.

The cytotoxic effects of three different bisphosphonates in-vitro on human gingival fibroblasts, osteoblasts and osteogenic sarcoma cells

“…The most frequently used BP and those responsible for ONJ are zoledronic acid (ZOL) and pamidronate (PAM), which are administrated intravenously and are given for malignant osteolytic lesions (Purcell and Boyd, 2005;Cafro et al, 2008). But numerous cases of ONJ have been reported in patients taking oral BP, mainly in the treatment of osteoporosis (Ruggiero et al, 2004;Hong et al, 2010;Yarom et al, 2010). The medications used in these cases are mostly alendronate, ibandronate and risedronate, with alendronate (FOS) being frequently reported to cause adverse reactions such as ONJ (Bocanegra-Pérez et al, 2009;Sedghizadeh et al, 2009).…”

Controlled Release of Bis(phosphonate) Pharmaceuticals from Cationic Biodegradable Polymeric Matrices

“…Etidronic acid belongs to the important class of antiresorption agents known as bis(phosphonates) (see Figure ) . Among the important structural features of these molecules, one can single out the position of the two phosphonate moieties that are covalently bonded to the same carbon atom.…”

Relationship Between Osteonecrosis of the Jaw and Bisphosphonate Treatment

“…Klinička slika uključuje isprva patološki tijek cijeljenja postekstrakcijske rane (bol i otečenost mekih tkiva), zatim ulceraciju rane s eksponiranjem čeljusne kosti, razvoj fi stule i naknadno gubljenje preostalih zubi. Progresijom bolesti navedene simptome može pratiti i parestezija donje usne (32,66). Osteonekroza čeljusti, osim lokalnih simptoma, stvara i poremećaj svakodnevne funkcije stomatognatskoga sustava, npr.…”