Oral bisphosphonate therapy and osteonecrosis of the jaw: what to tell the concerned patient.
Bisphosphonate-associated osteonecrosis of the jaw (BONJ) is encountered predominantly in cancer populations being treated with high-dose intravenous bisphosphonates for skeletal complications such as bone metastases and secondary fracture risk. A minority of BONJ lesions have been observed in patients receiving oral bisphosphonates for management of osteoporosis or osteopenia. In this paper, the current knowledge pertaining to the incidence, definition, and signs and symptoms of BONJ is presented, followed by a discussion of the incidence and consequences of osteoporotic skeletal fracture and the use of oral bisphosphonates to mitigate fracture. The risk of BONJ appears to be very small in patients taking oral bisphosphonates. In addition, the consequences of osteoporotic fracture likely have significantly greater mortality and morbidity than BONJ. Within this context, management concepts and guidelines are presented to help the dental clinician allay concerns about BONJ expressed by patients receiving oral bisphosphonate therapy.
Koka
Sreenivas
S
Metabolic Bone Disease Core Group, Division of Prosthodontics, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. koka.sreenivas@mayo.edu
Clarke
Bart L
BL
Amin
Shreyasee
S
Gertz
Morie
M
Ruggiero
Salvatore L
SL
D000284:Administration, Oral; D000970:Antineoplastic Agents / Q000009:adverse effects; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001851:Bone Diseases, Metabolic / Q000517:prevention & control; D004164:Diphosphonates / Q000009:adverse effects*; D050723:Fractures, Bone / Q000517:prevention & control; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D007262:Infusions, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D009369:Neoplasms / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D010024:Osteoporosis / Q000517:prevention & control; D000077268:Pamidronate; D010353:Patient Education as Topic; D012307:Risk Factors; D013997:Time Factors; D000077211:Zoledronic Acid
D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate