Concept, diagnosis and classification of bisphosphonate-associated osteonecrosis of the jaws. A review of the literature

Abstract

BackgroundBisphosphonates (BPs) and other antiresorptive agents such as denosumab are widely prescribed for the treatment of osteoporosis and are also used in patients with multiple myeloma and metastatic breast or prostate cancer for avoiding bone reabsorption and fractures that result in increased morbidity-mortality among such individuals.Material and MethodsWe made a bibliographic search to analyze the concept, diagnosis and the different classifications for bisphosphonate-associated osteonecrosis of the jaws.ResultsOsteonecrosis of the jaws (ONJ) is an important complication of exposure to BPs or other antiresorptive agents, and although its prevalence is low, it can pose management problems. The definition, diagnosis and classification of osteonecrosis have evolved since Marx reported the first cases in 2003.ConclusionsThe present study offers a literature review and update on the existing diagnostic methods and classification of the disorder, with a view to facilitating earlier and more effective treatment. Key words:Osteonecrosis, jaws, bisphosphonates.

Medication-related osteonecrosis of the jaws after tooth extraction in senescent female mice treated with zoledronic acid: microtomographic, histological and immunohistochemical characterization

“…While for humans there are established concept and classification for MRONJ [1,57,62], animal MRONJ models are not comparable in terms of diagnosis and can vary according to the protocol applied to trigger MRONJ (S1 Table). In humans, MRONJ is defined as an area of exposed bone in the oral cavity that does not heal within 8 weeks, in a patient who has been receiving or has been exposed to antiresorptive (nBPs or denosumab) or antiangiogenic therapy, and has not had radiation therapy in the craniofacial region [2,57].…”

“…In humans, MRONJ is defined as an area of exposed bone in the oral cavity that does not heal within 8 weeks, in a patient who has been receiving or has been exposed to antiresorptive (nBPs or denosumab) or antiangiogenic therapy, and has not had radiation therapy in the craniofacial region [2,57]. Although bone exposure is a part of diagnosis criteria, the current staging system proposed by the AAOMS [1,62] includes a variant of MRONJ without bone exposure (stage 0), with no clinical evidence of necrotic bone and/or infection. In our study, only 40% of ZA group animals clinically presented delayed epithelial socket closure compared to the Control (Fig.…”

Medication-related osteonecrosis of the jaws after tooth extraction in senescent female mice treated with zoledronic acid: Microtomographic, histological and immunohistochemical characterization

“…While for humans there are established concept and classification for MRONJ [1, 58, 63], animal MRONJ models are not comparable in terms of diagnosis and can vary according to the protocol applied to trigger MRONJ (S1 Table). In humans, MRONJ is defined as an area of exposed bone in the oral cavity that does not heal within 8 weeks, in a patient who has been receiving or has been exposed to anti-resorptive (nBPs or denosumab) or anti-angiogenic therapy, and has not had radiation therapy in the craniofacial region [2, 58].…”

Oral manifestation of systemic diseases—a perspective from an oral pathology diagnostic service

“…A search of our database showed 53 cases that were diagnosed between 2005 and July 2017 as bisphosphonate‐related, or medication‐related osteonecrosis of the jaw. More potent bisphosphonates that require less frequent administration are increasingly used for treatment of osteoporosis, while potent bisphosphonates continue to be used intravenously for treatment of multiple myeloma and metastatic carcinoma to bone (Gavalda & Bagan, ). A new class of anti‐resorptive medication that inhibits osteoclast maturation, function, and survival by binding to RANKL has been gaining in use over bisphosphonates in the past 5 or 6 years, for treatment of metastatic disease to bone and osteoporosis (Matsushita et al., ).…”