Updates on bisphosphonates and potential pathobiology of bisphosphonate‐induced jaw osteonecrosis

Abstract

Osteonecrosis of the jaws is a major complication associated with long-term use of bisphosphonates. While osteonecrosis can arise from other precipitating conditions, bisphosphonate-induced jaw osteonecrosis (BJON) is highly associated with long-term administration of pamidronate (Aredia) and zoledronic acid (Zometa), which are two intravenous bisphosphonate formulations. The underlying pathogenesis of BJON and its site-specific presentation still remain to be fully elucidated. This review will discuss clinically available bisphosphonates, current opinions, pathogenesis, and management guidelines for bisphosphonate-induced jaw osteonecrosis.

Dental extractions and bisphosphonates: the assessment, consent and management, a proposed algorithm

“…Bisphosphonates containing nitrogen in their side chain (also called aminobisphosphonates) also exhibit several antitumour effects, including the inhibition of tumour cell ability to invade bone and induction of tumour cell apoptosis. 2 Some antiangiogenetic properties have also been reported in animal studies. 3 …”

“…Interestingly the jaws are not recognised as at risk of corticosteroid-associated osteonecrosis. 2,11 However, the general osteoporosis induced by corticosteroid therapy and the risk of low impact fractures associated with it is such that the concurrent prescribing of a bisphosphonate has been recommended. Present guidelines advise that patients taking the equivalent dose of prednisolone 7.5 mg per day or more for >3 months should be considered for skeletal protection with a bisphosphonate or hormone replacement therapy.…”

Guidelines for the management of castrate-resistant prostate cancer

“…Good oral hygiene, baseline dental evaluation for highrisk individuals and avoidance of invasive dental surgery during therapy are recommended to reduce risk of ONJ [28][29][30] (Level 3 Evidence, Grade C recommendation). Zoledronic acid has been used safely with a variety of cytotoxic chemotherapies in clinical trials.…”

Ostéonécrose avasculaire des maxillaires après traitement d'un myélome multiple par bisphosphonates. A propos d'un cas

“…Cependant, ces BP sont à l'origine de nombreuses complications, dont l'ostéonécrose avasculaire des maxillaires [4] . L'étiopathogénie des ostéonécroses induites par les BP semble être liée à la susceptibilité des maxillaires par rapport aux autres os du squelette, à l'activité anti-ostéoclastique et anti-angiogenique des BP, au non couplement de l'équilibre ostéoclaste-ostéoblaste et à l'effet « bandwagon » qui augmente la susceptibilité des maxillaires à l'osteonécrose [1] . Cette complication est trouvée, le plus fréquemment, chez les patients atteints de myélome multiple, âgés de 61 ans en moyenne, de race blanche.…”

“…Parmi les médica-ments incriminés dans ces ostéonécroses, on retrouve le plus souvent les bisphosphonates (BP) lors du traitement du myélome multiple. En effet, les premiers cas ont été rapportés en 2003 et actuellement le nombre de cas d'ostéonécrose des maxillaires sous BP décrits dans la littérature avoisine 1500 cas [1][2][3] . Cette entité pathologique pose actuellement encore des problèmes, en particulier étiopathogéniques et thérapeutiques.…”