Osteonecrosis of the Jaw Associated With Bisphosphonate Use: Presentation of Seven Cases and Literature Review

Abstract

Increasing reports of bisphosphonate associated osteomyelitis and the difficulty in treating these patients requires further investigation to identify the subset of patients who are at increased risk for this process. The optimal and safe duration of treatment with bisphosphonates needs to be determined.

Association between bisphosphonates and jaw osteonecrosis: A study in Wistar rats

“…It is suspected that smoking, 32 chronic use of alcohol, 32,36 diabetes mellitus, 11 hypoproteinemia, 4 corticotherapy, chemotherapy, 6,12,14,15,37,38 immunosuppressive therapy, 12,36 endodontic lesions, periodontal disease, abscesses, 9 poor oral hygiene, 32 and renal insufficiency 27 are cofactors in the development of osteonecrosis by bisphosphonates. Therefore, it is necessary to consider that in the case of alendronate, 1 or more cofactors could exert an essential role in the development of osteonecrosis.…”

Bisphosphonate-induced Osteonecrosis of the Jaws: Review, Clinical Implications and Case Report

“…An analysis of these cases [28][29][30][31][32][33][34][35][36][37][38][39][40][41], including the current case, reveals a female predominance (206 women, 147 men), with a male-to-female ratio of 0.7:1. The (3) ABs; debridement (7) Breast carcinoma (1) ABs; maxillectomy (2) Lung carcinoma (4) Mandibular resection (1) Prostate carcinoma (2) Magopoulos [29] Breast carcinoma (18) HBO; ABs; surgery (6) ZA (33) Lung carcinoma (2) Cessation of BP; ABs (24) Prostate carcinoma (5) ABs (11) Neuroendocrine carcinoma (1) ABs; surgery (10) Fibrous dysplasia (1) Amyloidosis (1) Clarke [30] (1) Medical; surgical, not specified (10) ZA (5) Prostate carcinoma (1) Not specified (2) Metastatic lymphoma (1) No treatment (1) Osteoporosis (1) Mortensen [31] Risedronate (2) Osteoporosis (2) ABs; sequestrectomy (1) ABs (1) Rossi [32] Prostate carcinoma (2) Medical …”

“…The (3) ABs; debridement (7) Breast carcinoma (1) ABs; maxillectomy (2) Lung carcinoma (4) Mandibular resection (1) Prostate carcinoma (2) Magopoulos [29] Breast carcinoma (18) HBO; ABs; surgery (6) ZA (33) Lung carcinoma (2) Cessation of BP; ABs (24) Prostate carcinoma (5) ABs (11) Neuroendocrine carcinoma (1) ABs; surgery (10) Fibrous dysplasia (1) Amyloidosis (1) Clarke [30] (1) Medical; surgical, not specified (10) ZA (5) Prostate carcinoma (1) Not specified (2) Metastatic lymphoma (1) No treatment (1) Osteoporosis (1) Mortensen [31] Risedronate (2) Osteoporosis (2) ABs; sequestrectomy (1) ABs (1) Rossi [32] Prostate carcinoma (2) Medical (2) Osteoporosis (1) Neuroendocrine carcinoma (1) Fibrous dysplasia (1) (6) Breast carcinoma (10) ZA (9) Prostate carcinoma (1) Bagan [36] Breast carcinoma (6) ZA (2) Cheng [11] Debridement (1) Not specified…”

Recognizing the toxicity of “Nontoxic” drugs employed in the management of malignant disease

“…Unfortunately, the naïveté of this argument is becoming increasingly clear. From recent data revealing the risk of osteonecrosis of the jaw resulting from certain bisphosphonates [9]-to a heightened risk of thromboembolic disease following delivery of recombinant erythropoietin [10]-these products, which have unequivocally been shown to produce benefits, may also have negative consequences.…”