Systematic Review: Bisphosphonates and Osteonecrosis of the Jaws

Woo, Sook‐Bin; Hellstein, John W.; Kalmar, John R.

doi:10.7326/0003-4819-144-10-200605160-00009

Cited by 1,151 publications

(1,011 citation statements)

References 62 publications

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“…Accordingly, no differences in genes associated with angiogenesis were reported in multiple myeloma patients with NBPs related ONJ [17]. Thus, defective local circulation is unlikely to be responsible for the necrosis, contrary to previous deductions [19,30].…”

Section: Discussionmentioning

confidence: 68%

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

Lesclous

Najm

Carrel

et al. 2009

Bone

194

140

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Osteonecrosis of the jaw (ONJ) can be associated with nitrogen-containing bisphosphonates (NBPs) therapy. Various mechanisms of NBP-associated ONJ have been proposed and there is currently no consensus of the underlying pathogenesis. The detailed medical and dental histories of 30 ONJ patients treated with NBPs for malignant diseases (24) or osteoporosis (6) were analyzed. The necrotic bone was resected and analyzed histologically after demineralization. In 10 patients the perinecrotic bone was also resected and processed without demineralization. Alveolar bone samples from 5 healthy patients were used as controls. In 14 ONJ patients, serial technetium-99m-methylene diphosphonate scintigraphic scans were also available and confronted to the other data. Strong radionuclide uptake was detected in some patients several months before clinical diagnosis of ONJ. The medullary spaces of the necrotic bone were filled with bacterial aggregates. In the perinecrotic bone, the bacteria-free bone marrow characteristically showed an inflammatory reaction. The number of medullary inflammatory cells taken as an index of inflammation allowed us to discriminate two inflammation grades in the ONJ samples. Low-grade inflammation, characterized by marrow fibrosis and low inflammatory cells infiltration, increased numbers of TRAP + monoand multineacleated cells was seen in patients with bone exposure b 2 cm 2 . High-grade inflammation, associated with larger lesions, showed amounts of tartrate-resistant acid phosphatase + /calcitonin receptor − mono-and multinucleated cells, osteocyte apoptosis, hypervascularization and high inflammatory cell infiltration. The clinical extent of ONJ was statistically linked to the numbers of inflammatory cell. Taken together these data suggest that bone necrosis precedes clinical onset and is an inflammation-associated process. We hypothesize that from an initial focus, bone damage spreads centrifugally, both deeper into the jaw and towards the mucosa before the oral bone exposure and the clinical diagnosis of ONJ.

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Section: Discussionmentioning

confidence: 68%

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

Lesclous

Najm

Carrel

et al. 2009

Bone

194

140

View full text Add to dashboard Cite

show abstract

“…Cases of osteonecrosis of the jaw in patients treated with BP have been recently and increasingly reported, strongly suggesting a causal link [39]. Osteonecrosis of the jaw is usually painful and preceded by a dental procedure in 60% of cases.…”

Section: Post-treatment Changesmentioning

confidence: 99%

“…Osteonecrosis of the jaw is usually painful and preceded by a dental procedure in 60% of cases. Oversuppression of bone turnover and antiangiogenic effects of BP are considered to be contributing factors [39,40].…”

Section: Post-treatment Changesmentioning

confidence: 99%

Magnetic resonance imaging of bone marrow in oncology, Part 2

Hwang

Panicek

2007

Skeletal Radiol

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Magnetic resonance imaging plays an integral role in the detection and characterization of marrow lesions, planning for biopsy or surgery, and post-treatment followup. To evaluate findings in bone marrow on MR imaging, it is essential to understand the normal composition and distribution of bone marrow and the changes in marrow that occur with age, as well as the basis for the MR signals from marrow and the factors that affect those signals; these points have been reviewed and illustrated in part 1 of this two-part article. Part 2 will emphasize the practical application of MR imaging to facilitate differentiation of normal marrow, tumor, and treatment-related marrow changes in oncology patients, and will review complementary MR techniques under development.

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“…2 Bisphosphonates are analogues of pyrophosphate that are prescribed for diseases associated with intense bone resorption, such as Paget's disease, multiple myeloma, osteoporosis, bone tumours, and metastasis. [3][4][5] Bisphosphonate-induced osteonecrosis has been characterized as a necrotic bone area in the oral cavity that persists for longer than 8 weeks without a history of head and neck radiotherapy.…”

mentioning

confidence: 99%