Updates on osteonecrosis of the jaw

Abstract

Purpose of review-Osteonecrosis of the Jaw (ONJ) in an uncommon condition noted to occur in patients with cancer receiving intravenous bisphosphonates. The etiology of ONJ remains unknown. The leading hypotheses addressing the mechanism of ONJ are reviewed here.Recent findings-The present clinical data suggests that ONJ may occur in approximately 5% of patients with metastatic bone disease. The ability to predict an individual's risk of developing ONJ remains elusive. It is likely that an altered bone microenvironment and/or host defense mechanisms effected by medications used to treat patients with metastatic bone disease contributes to the development of ONJ. Medications that significantly reduce osteoclastic activity are associated with ONJ. Preclinical models of ONJ are being developed, but to establish such an intricate systemic condition in animals is challenging.Summary-The ONJ field has progressed via knowledge gained by case reports, population-based studies and emerging animal models. Still, there are myths that need to be resolved and important clues that need to be investigated. Understanding the pathophysiology of this condition will be critical to improve patient care. Communications between oncologists, dentists, basic scientists and patients are central to effective treatment and research for this condition.

The Impact of Vitamin D Status on Periodontal Surgery Outcomes

“…Results from animal studies suggest that vitamin D may play a predominant role in mandibular anabolic bone formation (Liu et al, 2009), and may exert positive effects on fracture healing (Fu et al, 2009). Vitamin D deficiency has also been associated with compromised osseous healing in the oral cavity in bisphosphonate-associated osteonecrosis of the jaw pre-clinical studies, supporting a role for vitamin D in bone healing in the oral cavity (Hokugo et al, 2010;Yamashita et al, 2010).…”

Multipotent mesenchymal stromal cell sheet therapy for bisphosphonate-related osteonecrosis of the jaw in a rat model

“…It has been suggested that the bone-remodeling rate is high in the jaw [14]. Thus, BPs may have a greater impact on the health of the jawbones than on other bones.…”

“…Although the etiology of BRONJ remains unclear, potential mechanisms have been proposed, including the over-suppression of bone turnover, suppression of angiogenesis, infection, soft tissue toxicity, and immune dysfunction [4,8,14]. It has been suggested that the bone-remodeling rate is high in the jaw [14].…”

Parathyroid Hormone Applications in the Craniofacial Skeleton

“…The pathogenesis of bisphosphonate-related osteonecrosis of the jaw has been speculated to be due to the impact of bisphosphonates on osteoclast survival, epithelial cells, endothelial cells, and immune cells (Yamashita et al , 2010). Bisphosphonates exert their anti-resorptive activity by suppression of osteoclasts.…”