Bisphosphonate-related osteonecrosis of the jaws – Characteristics, risk factors, clinical features, localization and impact on oncological treatment

Otto, Sven; Schreyer, Christian; Häfner, S.; Mast, Gerson; Ehrenfeld, Michael; Stürzenbaum, Stephen R.; Pautke, Christoph

doi:10.1016/j.jcms.2011.05.003

Cited by 220 publications

(207 citation statements)

References 36 publications

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“…· Second and third stages: include patients with exposed bone of various extents with other concomitant symptoms and signs that are mainly a result of secondary infection of the necrotic bone. The symptoms may include increased tooth mobility, formation of sinus tracts, suppuration and traumatic ulceration of oral mucosa adjacent to exposed bone, mandibular fracture, and/or cervical lymphadenopathy 18) . In the past, many studies worldwide have reported the diagnosis of BRONJ.…”

Section: Discussionmentioning

confidence: 99%

Change in the Magnetic Resonance Imaging Signal of the Mandibular Condyle Due to Bisphosphonate-Related Osteonecrosis of the Jaw

Hirahara

Muraoka

Noda

et al. 2017

J. Hard Tissue Biology.

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Marx was the first to report osteonecrosis of the jaw due to administration of BPs in 2003. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is the result of an adverse drug reaction. Moreover, many studies worldwide have reported an association between a range of serious dental diseases and the use of bisphosphonates (BPs). Few studies, however, have evaluated BRONJ based on an abnormal signal detected by MRI in the bone marrow of the mandibular condyle. The aim of this study was to assess changes in the magnetic resonance imaging (MRI) signal from the mandibular condyle that could be due to BRONJ. In particular, we focused on the presence of an abnormal MRI signal emanating from mandibular condyle bone marrow. Twenty-eight patients (11 men, 17 women; 56 temporomandibular joints) with BRONJ were evaluated for jaw pain. The patients, whose mean age was 72.9 ± 9.4 years (range 48 -88 years), underwent MRI examination of the jawbone at our hospital from August 2006 to December 2015 and were included in the study. Overall, 80.0% of the patients diagnosed with BRONJ exhibited an abnormal bone marrow signal in the mandibular condyle on the same side of the face that suffered jaw pain. This abnormal signal was present significantly more frequently on the side of the face with the jaw symptoms than on the side without symptoms. Patients with BRONJ displayed an abnormal MRI signal in the mandibular condyle on the side of the face with jaw symptoms, suggesting that MRI findings could be useful clinically for detecting BRONJ in the mandibular condyle.

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Section: Discussionmentioning

confidence: 99%

Change in the Magnetic Resonance Imaging Signal of the Mandibular Condyle Due to Bisphosphonate-Related Osteonecrosis of the Jaw

Hirahara

Muraoka

Noda

et al. 2017

J. Hard Tissue Biology.

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“…This issue is important as long-lasting inhibition of bone resorption can lead to increased bone fragility and therefore, to fractures caused by an inability to replace old bone with new bone and to repair microcracks [98,99].…”

Section: Effect Of Bisphosphonates On the Mechanical Properties Of Bonementioning

confidence: 99%

“…Recent human studies have shown that alendronate actually increases vertebral and non-vertebral fractures [98]. Therefore, it is prudent to administer a dose that does not induce too great an inhibition of turnover.…”

Section: Effect Of Bisphosphonates On the Mechanical Properties Of Bonementioning

confidence: 99%

“…While some authors believe that bisphosphonate toxicity to gastrointestinal cells is the result of inhibition of farnesyl pyrophosphate synthase (FPPS) in the mevalonate pathway [78], it is generally believed that a compromised integrity of the mucosal epithelium alone is not enough to allow uninterrupted access to the bone surface and that a local immune response must also be compromised. It has been postulated that the acidity of local tissue (reduced pH) is altered by changes in the oral mucosa, periodontal disease, ill-fitting dentures, or dental surgery, thereby increasing the release of bisphosphonates to rise to potentially toxic levels [97,98,121]. These effects are believed to depress bone remodelling of the jaws and therefore impair wound healing.…”

Section: Direct Toxicity To Oral Mucosal Cellsmentioning

confidence: 99%

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“Bisphosphonates: Possible Modes of Action and Implications for Dental Implant Treatment. A Review of the Literature”

Ballantyne¹

2016

J Gen Pract

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“…Risk factors mainly include: injuries associated with treatment in dental surgery, use of mismatched prosthetic restorations, presence of bone exostosis, odontogenic inflammations, poor oral hygiene, coexisting diabetes, simultaneous chemotherapy and/or steroid treatment, malnutrition and smoking. [13][14][15] The route of BP administration has a great impact. The risk of BRONJ is greater for intravenous therapy (0.8-15%).…”

mentioning

confidence: 99%

Bone necrosis associated with the use of bisphosphonates: Case report

Jachewicz¹,

Jakiel²

2017

Dent. Med. Probl.

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The aim of this study was to present the case of a 68-year-old female patient with jaw bone necrosis associated with the use of bisphosphonates. The case was qualified for the second degree of severity (BRONJ). The study demonstrates a multi-month observation of the patient and describes the sequestrectomy procedure performed, which was supplemented by covering the bone tissue with a collagen sponge. The treatment applied was slightly different from the accepted algorithms of proceedings. The difference was connected with the use of a collagen sponge containing gentamicin (used to cover the bone's surface) after the sequestrectomy. The collagen material, in contrast to the exposed dead bone, is a surface which may be susceptible to epithelization. This gives a possibility to the secondary closing of the wound as a result of granulation and epithelization without the bone's re-exposure. Moreover, the study characterizes indications for the use of bisphosphonates, their chemical structure and mechanism of action. It shows the definition of BRONJ (bisphosphonate-related osteonecrosis of the jaw) and risk factors for its occurrence, as well as prevention and treatment methods.

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Bisphosphonate-related osteonecrosis of the jaws – Characteristics, risk factors, clinical features, localization and impact on oncological treatment

Abstract: The development of ONJ has a multi-factorial aetiology and the clinical presentation can vary markedly. ONJ cannot only impair the quality of life but also the treatment of the underlying disease.

Cited by 220 publications

References 36 publications

Change in the Magnetic Resonance Imaging Signal of the Mandibular Condyle Due to Bisphosphonate-Related Osteonecrosis of the Jaw

Change in the Magnetic Resonance Imaging Signal of the Mandibular Condyle Due to Bisphosphonate-Related Osteonecrosis of the Jaw

“Bisphosphonates: Possible Modes of Action and Implications for Dental Implant Treatment. A Review of the Literature”

Bone necrosis associated with the use of bisphosphonates: Case report

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