Novel insight into the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ)

Abstract

Summary Bisphosphonate-related osteonecrosis of the jaw (BRONJ), characterized by refractory bone exposure, has recently emerged as a serious side effect of bisphosphonate (BPs) treatment. We discuss novel insights that may help to improve the efficacy of BRONJ treatment and prevention. Our report highlights the following: (1) The presence of exposed bone in patients taking BPs does not necessarily reflect BRONJ, and diagnoses of oral ulceration with bone sequestration and malignancy must be excluded. (2) Osteonecrosis type of BRONJ is difficult to avoid using preventive dental measures alone. However, as with osteomyelitis type of BRONJ, preventive dental measures are indispensable for reducing the risk of secondary infection and disease progression. (3) The importance of tooth extraction as a risk factor for BRONJ among patients taking BPs has been overstated, particularly when they are administered at low doses. Delaying tooth extraction may increase the risk for the onset and progression of osteomyelitic BRONJ. (4) In patients taking low doses of BPs, dental implant surgery is not necessarily contraindicated if there are no other risk factors, such as combined use of corticosteroids or concomitant diabetes. However, the risk of BRONJ due to peri-implantitis must be explained when obtaining patient consent.

Zoledronic acid regulates the synthesis and secretion of IL-1β through Histone methylation in macrophages

“…They are widely used for bone-metastatic cancers, multiple myeloma, osteoporosis, osteogenesis imperfecta and Paget's disease 1 . Since reported by Marx in 2003 2 , bisphosphonate-related osteonecrosis of the jaw (BRONJ) has emerged as a serious side effect of BP treatment, especially nitrogen-containing bisphosphonates (NBPs), such as zoledronic acid (Zol) 3 . Risk factors such as operative treatment, concomitant oral disease, chemotherapeutics, anti-angiogenic agents and steroids are related to the pathogenesis of BRONJ 4 .…”

Comprehensive Study of the Risk Factors for Medication-Related Osteonecrosis of the Jaw Based on the Japanese Adverse Drug Event Report Database

“…Atypical femoral fracture is reported to be affected by BP-induced osteoclast suppression [ 34 ]. Some patients with MRONJ have jaw osteomyelitis [ 35 ]. Thus, some patients with MRONJ with jaw osteomyelitis may have been reported as osteomyelitis.…”

Osteonecrosis Mandibular Extended to Bisphosphonates: A Very Rare Extensive Case

“…After the first report of BRONJ in 2003 [1][2][3], the AAOMS modified the term into MRONJ to emphasize the role of drugs causing ONJ [4,6]. Additional studies have indicated that ONJ can be caused by single agent of corticosteroids, methotrexate, and recreational or illicit drugs such as cocaine, amphetamine, and methamphetamine [7]. However, local factors in the oral cavity, despite being absent from the formal definition of MRONJ, also increase risk and play a crucial role in the disease process [8][9][10].…”