ReviewBisphosphonate osteonecrosis of the jaw: A historical and contemporary review
Section snippets
Bisphosphonate drugs
Bisphosphonates (BP) are pyrophosphate analogues, which share a common phosphorous–carbon–phosphorous chemical core. These compounds have been synthesised, and used in industry since the 19th century but it is only in the 1960s that their in-vitro ability to inhibit the precipitation of calcium phosphate was applied clinically.1 Their principal action is to inhibit resorption of bone, which results in an increase in the mineral density of bone and a reduction in serum calcium.2
They are poorly
History of bisphosphonate associated osteonecrosis of the jaw (BONJ)
Osteonecrosis of the jaws may be associated with a number of different predisposing conditions, with its pathophysiology varying with the predisposing factors.
The risk of osteonecrosis associated with phosphorous compounds was first described in the 19th century in workers in the matchmaking industry who presented with pain, exposure of the jaw bone and infection associated with sequestration. The term ‘phossy jaw’ was coined for these patients, who often followed an indolent but progressive
Management
The aims of treating patients with BONJ are to eliminate clinical symptoms such as pain, treat any infection of the soft tissues or bone, and minimise the progression of bone necrosis.15 Clinical markers of success include an intact mucosa with no signs of infection or sinus formation and radiographic markers include the arrest of progression of the bony abnormality or remodelling of the affected area.29 It is not expected that treatment will lead to resolution of all mucosal lesions, but
Conclusions
Bisphosphonate osteonecrosis of the jaws is an uncommon, but potentially very serious adverse consequence of BP drug therapy. It is mostly associated with the use of more potent amino-bisphosphonates for extended periods of time.
The most common preceding event to the development of clinical lesions is invasive dental treatment, and it is therefore particularly important that dental health professionals have an understanding of its causes and management.
Prevention remains the most important
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2019, International Journal of Oral and Maxillofacial SurgeryRecommendations for the Prevention of Bisphosphonate-Related Osteonecrosis of the Jaw: A Systematic Review
2018, Journal of Evidence-Based Dental PracticeCitation Excerpt :It is estimated that an annual cost of all osteoporotic fractures is approximately $20 billion in the United States and $30 billion in the European Union.3 Therapeutic use of bisphosphonates has increased dramatically worldwide, particularly in the treatment of bone diseases such as osteoporosis, but bisphosphonates are also used in the management of many other nonmalignant and malignant conditions.4,5 The main biological action of bisphosphonates is to reduce bone resorption both by inhibiting osteoclast function and by inducing apoptosis in osteoclasts.6
Pathophysiology of Osteonecrosis of the Jaws
2015, Oral and Maxillofacial Surgery Clinics of North AmericaCitation Excerpt :ZA is a known agent that reduces circulating VEGF levels in vivo in patients with cancer and reduces angiogenesis in vitro.78–80 ZA inhibits proliferation and interferes with adhesion and migration of human endothelial cells,4,78 which is thought to interrupt tumor invasion and metastases.4,80 In addition, all BPs, especially nitrogen-containing BPs, induce a statistically significant decrease in microvessel density in vivo.81