Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

“…Even if the longer-term use of oral BPs should have a dose equivalence effect [48], it is notable that the mean time of presentation was approximately 3 yrs (38 months) in the patients in this study, as already described in the literature [12,16,35]. Such a fact would indicate that the short time period of BP exposure may not always necessarily constitute a safety threshold relating to the risk of BRONJ in any given patient and, in every case, the tailoring of BP therapy to individual patients would be beneficial.…”

Bisphosphonate-associated osteonecrosis of the jaw: A key role of inflammation?

“…Among them nitrogen-containing bisphosphonates (NBPs) are the most potent in inhibiting bone resorption [1]. Osteonecrosis of the jaw (ONJ) associated with NBPs therapy is a recently described detrimental effect first reported in 2003 [2]. ONJ is characterized by an area of exposed bone in the maxillofacial region that does not heal within 8 weeks, in a patient who has no metastasis or radiation therapy in the craniofacial region [3].…”

Management of atrophic maxilla in severe osteoporosis treated with bisphosphonates: a case report

“…For instance, several cases of ONJ have been reported in patients treated with BPs after oral surgery procedures, 25,26 as well as the antiangiogenic and ONJ effect of BPs. [41][42][43] Current theory suggests that the mechanism of bisphosphonate ONJ is related to the high metabolic biology of the jawbones, which leads to enhanced concentration of the agents there. Reduction of osteoclastic remodeling promotes acellular bone formation and subsequent necrosis with the inability to heal.…”

“…Reduction of osteoclastic remodeling promotes acellular bone formation and subsequent necrosis with the inability to heal. 42 Little is known of the risks associated with long-term use of oral BPs despite their use for more than 10 years as an oral mode of delivery for the treatment of osteopenia, osteoporosis, and Paget disease of bone. Some authors reported in a controlled study that problems with implants in patients taking oral BPs are relatively rare.. 27 Furthermore, BPs demonstrate the potential to oversuppress bone turnover rates and inhibit angiogenesis, thus impairing the reparative properties of bone, 42,44,45 which is why the angiogenic properties of PRP could be beneficial for bone healing in such patients.…”

“…42 Little is known of the risks associated with long-term use of oral BPs despite their use for more than 10 years as an oral mode of delivery for the treatment of osteopenia, osteoporosis, and Paget disease of bone. Some authors reported in a controlled study that problems with implants in patients taking oral BPs are relatively rare.. 27 Furthermore, BPs demonstrate the potential to oversuppress bone turnover rates and inhibit angiogenesis, thus impairing the reparative properties of bone, 42,44,45 which is why the angiogenic properties of PRP could be beneficial for bone healing in such patients. 46,47 Recently Fugazzotto et al reported that after a mean period of 3.3 years (range 1-5 years) of oral BP use, no correlation was found with the development of osteonecrosis after implant placement.. 48 Cartsos et al claimed that the mode of BP use results in different risk profiles for developing ONJ.…”