Osteonecrosis of the jaw and bisphosphonate use in breast cancer patients

Abstract

It is renowned that breast cancer patients suffer from a number of cancer-related skeletal events, while drugs recently added to the practitioners' quiver, such as aromatase inhibitors, intensify the need to preserve bone mass in this group of patients. Bisphosphonates are potent inhibitors of both normal and pathologic bone resorption. Besides their apoptotic and antiproliferative activity on osteoclasts, bisphosphonates can also exert various effects on macrophages, keratinocytes and fibroblasts. Bisphosphonate-related osteonecrosis of the jaw is a complication that emerged after broad clinical use of bisphosphonates, and which has not yet been adequately described in a clinical trial setting. The purpose of this review is to critically reflect the incidence, etiopathogenesis, prevention and treatment of osteonecrosis of the jaw. Succinct suggestions are provided to ensure clinicians prevent and detect the complications early.

Osteonecrosis of the jaw in patients receiving oral bisphosphonates

“…We recently provided more solid evidence to support this argument through a longitudinal cohort study of 1,621 patients who received intravenous BP in our institution [3]. Therefore, we argue that root canal treatment is a dental treatment modality that can be safely applied to patients receiving intravenous bisphosphonates [2][3][4]. Moreover, we propose that root canal treatment should be an alternative to avoid dental extractions [4].…”

“…Therefore, we argue that root canal treatment is a dental treatment modality that can be safely applied to patients receiving intravenous bisphosphonates [2][3][4]. Moreover, we propose that root canal treatment should be an alternative to avoid dental extractions [4].…”

Erratum

“…A comprehensive graphic summary of this hypothesis has been published. 4 Allen and Burr 1 concluded that other important areas related to ONJ surely exist, that the initiation of hypothesisdriven studies is essential to further elucidate the etiopathogenesis of ONJ, and that interest in ONJ within the research community will wane if the field does not move forward. In this context, these hypotheses accommodate important consequences for clinician practice and research.…”

Bisphosphonate-related osteonecrosis of the jaw in randomized clinical trials

“…4. Reading [4], increasing bisphosphonate accumulation in the skeleton with time may lead to ONJ development. Incidentally, the majority of ONJ cases are reported to occur after administration of over six bisphosphonate doses [5].…”

“…Future, prospective epidemiological efforts from academic researchers will support or reject the latter argument. Until then, caution should be paid to the preventive measures suggested by various organizations [4] for every patient receiving bisphosphonates.…”