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      Nitrogen containing bisphosphonates associated osteonecrosis of the jaws: A review for past 10 year literature

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          Abstract

          Nitrogen containing bisphosphonate (N-BP) therapy is used extensively to treat osteoporosis and osteolytic bone lesions. Recently, a special form of osteonecrosis limited to the maxillofacial skeleton has been discovered especially within those patients who are receiving either long-term N-BP therapy alone and/or associated with invasive dental procedure. Bisphosphonates accumulate almost exclusively in maxillofacial skeleton owing to high bone turn over remodeling to maintain the mechanical competence. The pathogenesis and why it commonly appears in maxillofacial skeleton and the fixed treatment strategies remains unknown. The aim of this study was to improve the clinician understanding of N-BPs associated osteonecrosis of maxillofacial skeleton by reviewing the past 10 year literature.

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          Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases.

          T. Rosenberg, Bhoomi Mehrotra, L. Ruggiero … (2004)
          Bisphosphonates are widely used in the management of metastatic disease to the bone and in the treatment of osteoporosis. We were struck in the past 3 years with a cluster of patients with necrotic lesions in the jaw who shared 1 common clinical feature, that they had all received chronic bisphosphonate therapy. The necrosis that was detected was otherwise typical of osteoradionecrosis, an entity that we rarely encountered at our center, with less than 2 patients presenting with a similar manifestation per year. We performed a retrospective chart review of patients who presented to our Oral Surgery service between February 2001 and November 2003 with the diagnosis of refractory osteomyelitis and a history of chronic bisphosphonate therapy. Sixty-three patients have been identified with such a diagnosis. Fifty-six patients had received intravenous bisphosphonates for at least 1 year and 7 patients were on chronic oral bisphosphonate therapy. The typical presenting lesions were either a nonhealing extraction socket or an exposed jawbone; both were refractory to conservative debridement and antibiotic therapy. Biopsy of these lesions showed no evidence of metastatic disease. The majority of these patients required surgical procedures to remove the involved bone. In view of the current trend of increasing and widespread use of chronic bisphosphonate therapy, our observation of an associated risk of osteonecrosis of the jaw should alert practitioners to monitor for this previously unrecognized potential complication. An early diagnosis might prevent or reduce the morbidity resulting from advanced destructive lesions of the jaw bone.
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            Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws.

            Sook-Bin Woo, John Hellstein, John R Kalmar (2006)
            Osteonecrosis of the jaws is a recently described adverse side effect of bisphosphonate therapy. Patients with multiple myeloma and metastatic carcinoma to the skeleton who are receiving intravenous, nitrogen-containing bisphosphonates are at greatest risk for osteonecrosis of the jaws; these patients represent 94% of published cases. The mandible is more commonly affected than the maxilla (2:1 ratio), and 60% of cases are preceded by a dental surgical procedure. Oversuppression of bone turnover is probably the primary mechanism for the development of this condition, although there may be contributing comorbid factors. All sites of potential jaw infection should be eliminated before bisphosphonate therapy is initiated in these patients to reduce the necessity of subsequent dentoalveolar surgery. Conservative débridement of necrotic bone, pain control, infection management, use of antimicrobial oral rinses, and withdrawal of bisphosphonates are preferable to aggressive surgical measures for treating this condition. The degree of risk for osteonecrosis in patients taking oral bisphosphonates, such as alendronate, for osteoporosis is uncertain and warrants careful monitoring.
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              Osteonecrosis of the jaw: who gets it, and why?

              Ian R Reid (2009)
              Osteonecrosis of the jaw (ONJ) is now defined by the presence of exposed bone in the mouth, which fails to heal after appropriate intervention over a period of six or eight weeks. It is commonly precipitated by a tooth extraction in patients treated with zoledronate, pamidronate or a combination of these agents, for the management of myeloma, breast cancer or prostate cancer. In patients with these malignancies who are treated with bisphosphonates, the overall prevalence is about 5%. There is a need to clearly delineate the incidence of ONJ in osteoporosis patients treated with bisphosphonates, and in appropriate control populations. Based on current evidence, the risk of ONJ in osteoporosis appears to be comparable to that in the general population. It is likely that ONJ results from direct toxicity to cells of bone and soft tissue from high potency bisphosphonates, probably acting through their effects on the mevalonate pathway. The bone in ONJ lesions does not appear to be 'frozen', rather there is very active resorption present, probably stimulated by local infection. This is likely to result in the local release at high concentrations of bisphosphonates. Management focuses on prevention, treatment of infection and cessation of bisphosphonates. The role of surgery is unclear.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Dent Res J (Isfahan)
                Journal ID (iso-abbrev): Dent Res J (Isfahan)
                Journal ID (publisher-id): DRJ
                Title: Dental Research Journal
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1735-3327
                ISSN (Electronic): 2008-0255
                Publication date (Print): Mar-Apr 2014
                Volume: 11
                Issue: 2
                Pages: 147-153
                Affiliations
                [1 ]Department of Oral and Maxillofacial Surgery, R. D. Dental Hospital and Research Centre, Patna, Bihar, India
                [2 ]Consultant Oral and Maxillofacial Surgeon, Gorakhpur, U.P., India
                Author notes
                Address for correspondence: Dr. Vijay Kumar, R. D. Dental Hospital & Research Centre, Patna, Bihar, India. E-mail: vijaypraveenmds@ 123456gmail.com
                Article
                Publisher ID: DRJ-11-147
                PMC ID: 4052638
                PubMed ID: 24932183
                SO-VID: 6fe6d4a5-40af-418a-8faa-ac959e0be13d
                Copyright © Copyright: © Dental Research Journal
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : September 2012
                Date accepted : May 2013
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Dentistry
                Keywords: nitrogen containing bisphosphonates,osteonecrosis of the jaw,staging and treatment strategies
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: nitrogen containing bisphosphonates, osteonecrosis of the jaw, staging and treatment strategies

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