Elsevier

The Surgeon

Volume 10, Issue 1, February 2012, Pages 36-42
The Surgeon

Review
Bisphosphonate osteonecrosis of the jaw: A historical and contemporary review

https://doi.org/10.1016/j.surge.2011.09.002Get rights and content

Abstract

The use of bisphosphonate drugs has been popularised in the late 20th century for the management of many conditions associated with abnormalities of bone turnover, particularly metastatic and haematogenous malignancy and osteopenia. The increase in indications for the use of bisphosphonates was supported by what was thought to be a very good safety profile. However in 2003 cases of osteonecrosis related to the use of bisphosphonates were first described.

The pathogenesis, and with this the explanation of why it only appears to affect the maxillofacial skeleton, and the best way of managing this problem remains unknown.

In this review we examine the process of identification of this pathology and the development of guidelines from medical societies and professional bodies on the management of patients before commencing bisphosphonate therapy, requiring dental treatment whilst on therapy, or with a diagnosis of bisphosphonate associated osteonecrosis of the jaws.

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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