Oral Bisphosphonate Related Osteonecrosis of the Jaw: A Challenging Adverse Effect

Abstract

Oral bisphosphonates are the most commonly prescribed antiresorptive drugs for the treatment of osteoporosis. However, there are several adverse effects associated with oral bisphosphonates including the bisphosphonate related osteonecrosis of the jaw (BRONJ). With a better understanding of this side effect, reported incidences for BRONJ in oral bisphosphonate users have increased in time. The pathogenesis of BRONJ has not been well determined. Several risk factors such as dentoalveolar surgery, therapy duration, and concomitant steroid usage have been linked to BRONJ. Conservative and surgical methods can be preferred in the treatment. Preventative measures are of great importance for the patients at high risk. In this paper, osteonecrosis of the jaw secondary to oral bisphosphonates was reviewed in order to increase awareness as well as to renew the current knowledge.

Comparing Variable-Length Polyglutamate Domains to Anchor an Osteoinductive Collagen-Mimetic Peptide to Diverse Bone Grafting Materials

“…However, the use of bisphosphonate as an anchoring domain introduces a nonneeded pharmacologic agent into the graft site, and some clinicians may be wary of this approach given the link between bisphosphonates and osteonecrosis of the jaw. 36,37 For domains incorporating noncanonical amino acids, chemical synthesis may be more complex than that required for standard polyglutamate or polyaspartate sequences.…”

Knowledge of bisphosphonate-related osteonecrosis of the Jawsamong Mexican dentists

“…Bisphosphonate-related osteonecrosis is an infrequent but potentially serious problem (1,4). Its treatment remains complex, and in some cases can be aggressive and mutilating (5,6). Despite the extensive scientific and non-scientific literature on the subject, many Mexican physicians and dentists lack the knowledge about bisphosphonate-related osteonecrosis, or underestimate its risks - a fact that can have important consequences for patient health.…”

Microsurgical Reconstruction After Bisphosphonate-Related Osteonecrosis of the Jaw

“…3,15 The BRONJ lesions are more commonly observed in the mandible than in the maxilla with a 2:1 ratio. This could be explained either by a selective accumulation of BP in bones with higher turnover such as the maxilla and the mandible or by the continuous exposure of these bones to the outside environment through the teeth.…”

“…1,3,9 Several serologic bone markers for predicting BRONJ development have been proposed, but their clinical usefulness is still controversial. 1,2,15 Before treatment with an IV BP, the patient should have a thorough oral examination, and all invasive dental procedures should be completed, achieving an optimal oral health. 18,19 The CTX test measures an octapeptide fragment of collagen cleaved by the collagenase of osteoclasts during bone resorption.…”