Osteopathology of the jaw associated with bone resorption inhibitors: what have we learned in the last 8 years?

Abstract

This summary of patient data and literature shows that knowledge about bisphosphonate-associated osteopathology of the jaw becomes more and more specific. The range of drugs associated with this disease has increased, but also therapeutic options show more and more success. Classifications, published shortly after the discovery of BRONJ need to be revised and new knowledge included.

Osteonecrosis of the Jaw in Patients With Metastatic Renal Cell Cancer Treated With Bisphosphonates and Targeted Agents: Results of an Italian Multicenter Study and Review of the Literature

“…33,[47][48][49][50] From the integrated analysis of 3 large randomized trials that compared zoledronic acid and denosumab, the estimated frequency of ONJ in RCC patients was even greater. [51][52][53] In fact, as already outlined, 54 there were 6 RCC patients among 89 patients treated with zoledronic acid or denosumab and adjudicated as ONJ cases (6.7%), whereas the total number of enrolled RCC patients was 155.…”

Long-term benefits versus side-effects from bone-targeted therapies for cancer patients

“…However, in some series, the real-world rates of ONJ are far higher than the 0-4% reported in controlled trials [46,47]. Although cumulative dose and duration of therapy are the most important risk factors for ONJ, tooth extractions, dental implant placement, periodontal procedures and infections, all contribute to osseous injury [38,49,50]. There may also be an association between ONJ, bisphosphonates and antiangiogenic treatments with agents such as bevacizumab [52,53].…”

“…Osteonecrosis of the jaw (ONJ) is related not only to bone-targeted therapy, but also to dental trauma [38,[46][47][48][49][50]. Rates of ONJ are similar with bisphosphonates and denosumab in clinical trials [51].…”

McCune-Albright Syndrome – The Difficult Therapeutic Strategy in the Context of Multiple Tissue Damage: Fibrous Dysplasia, Acromegaly and Cushing Syndrome

“…Still the safety of long-term administration in children needs further investigation. The most frightening complication of this therapy is the bisphosphonate-related osteonecrosis of the jaw (BRONJ) (29), especially when there is an association with aggravating factors such as: intravenous amino bisphosphonates, long duration of treatment, dental procedures or surgical procedures of the mandible (30). Since our patient envisaged a contouring surgery of the left maxilla and mandible, we considered that prescribing an antiresorptive drug would be an unnecessary risk and we looked for other viable options for pain relief.…”