Bisphosphonate Induced Osteochemonecrosis of the Jaws: An Ounce of Prevention May be Worth a Pound of Cure

Abstract

Patient exposure to bisphosphonate drugs for the management of hypercalcemia of malignancy, osteolytic lesions of metastatic cancer and osteoporosis has led to increasing reports of osteochemonecrosis of the jaws (bis-phossy jaw). This serious and debilitating condition requires dental practitioners to be alert for signs and symptoms of this syndrome. Thus far, nitrogen containing bisphosphonates have been implicated as a causative agent. While only a small fraction of patients who have taken these agents will develop osteochemonecrosis, it seems that patients who have received intravenous bisphosphonates are at greater risk than those who have taken oral agents. Tooth extractions are the most frequently reported predisposing dental procedure. While appropriate management strategies for patients with osteochemonecrosis of the jaws are evolving, we are suggesting rational preventive protocols and therapies based upon current experience and knowledge. These recommendations may change over time as the profession gains more experience in managing these patients.

Osteopathology induced by bisphosphonates and dental implants: clinical observations

“…Because BRONJ is a major concern for patients and there is no remodeling tendency in the affected bone, BP medication became a new and important risk issue for dentists in general daily practice. Many efforts have been made to prevent this localized bone disease [5,6]. Thus, many guidelines and prevention protocols have been developed to guide the dental treatment of patients before and during BP medication [7,8].…”

Bisphosphonate-Based Strategies for Bone Tissue Engineering and Orthopedic Implants

“…10,30 Since 2003, many publications have reported an association between bisphosphonate therapy and osteonecrosis of the jaws. [166][167][168][169][170][171][172] Most precisely, a correlation between the types of bisphosphonate, the period of the treatment, and the occurrence and gravity of osteonecrosis of the jaws has been proposed. 167 Most of the reported cases corresponded to intravenous therapy with high doses of amino-group-containing BPs such as zoledronic acid or pamidronate for malignant disease.…”

Dental endosseous implants in the medically compromised patient1

“…A further potential complication in osteoporotic patients is the possible effects on bone turnover at the OI interface of systemic medication used to manage the problem. Failures in patients using bisphosphonate therapy are well recognized (33) but it is now evident that bisphosphonates, and Pamidronate, Zoledronate and Alendronate, in particular, are linked to painful refractory bone exposures (sometimes termed osteochemonecrosis) in the jaws, although this complication is more common in patients who have received intravenous agents in high doses, usually for the management of hypercalcemia of malignancy (34). Although the precipitating event that produces this complication may be spontaneous, there is little doubt that surgery (exodontia, periodontal and endosseous implants) can be responsible (35).…”