Bisphosphonate-Induced Exposed Bone (Osteonecrosis/Osteopetrosis) of the Jaws: Risk Factors, Recognition, Prevention, and Treatment

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

“…BRONJ prevalence in cancer patients (range 3-18%) has been the focus of the majority of papers [3,55] to date, whereas the impact of BRONJ in non-cancer patients, with osteoporosis or Paget disease, who receive lower doses of BPs is less known [34,37]. The estimated prevalence of BRONJ in non-cancer (mainly osteoporotic) patients may range from 0.02% to 11% [22][23][24]29,33,36,42,44,47,49].…”

Management of atrophic maxilla in severe osteoporosis treated with bisphosphonates: a case report

“…For instance, several cases of ONJ have been reported in patients treated with BPs after oral surgery procedures, 25,26 as well as the antiangiogenic and ONJ effect of BPs. [41][42][43] Current theory suggests that the mechanism of bisphosphonate ONJ is related to the high metabolic biology of the jawbones, which leads to enhanced concentration of the agents there.…”

“…Although ONJ has been associated with the prolonged use of BPs, there is limited information about the risk of ONJ among users of oral BPs or about the magnitude of the risk among users of intravenous BPs. [25][26][27] Recently the potential benefits of using platelet-rich plasma (PRP) in optimal osseous wound repair have been reported. 28,29 Platelet-rich plasma is a fibrin adhesive with a higher platelet concentration, easily obtained from whole blood centrifugation, and contains angiogenic and mitogenic growth factors derived from the platelets' alpha granules.…”

Long-term safety of monthly zoledronic acid therapy beyond 1 year in patients with advanced cancer involving bone (LoTESS): A multicentre prospective phase 4 study

“…Since 2003, guidelines have been instituted to reduce the risks of renal impairment and ONJ in patients treated with ZOL (Berenson, 2005; Brantus et al., 2011; Cassinello Espinosa et al., 2012; Hillner et al., 2003; Kyle et al., 2007; Marx, Sawatari, Fortin, & Broumand, 2005). Currently, serum creatinine is monitored for renal function before each dose, with an initial dose reduction from the standard 4 mg based on pre‐treatment creatinine clearance, or treatment interruption based on the level of serum creatinine increase during treatment.…”

“…Currently, serum creatinine is monitored for renal function before each dose, with an initial dose reduction from the standard 4 mg based on pre‐treatment creatinine clearance, or treatment interruption based on the level of serum creatinine increase during treatment. A dental exam and all invasive procedures should be performed before initiating ZOL treatment, and prophylactic antibiotics are recommended for necessary dental procedures during treatment (Marx et al., 2005). Implementation of these guidelines should allow for the safe use of ZOL beyond 1 or 2 years, without increased risks of ONJ or renal impairment.…”