Osteonecrosis of the jaw and bisphosphonates: a comparison with white phosphorus, radium, and osteopetrosis.
BACKGROUND
Recent reports of bisphosphonate-associated jaw osteonecrosis are reminiscent of earlier incidents in which a comparable syndrome was caused by occupational exposure to white phosphorus or radium. Osteonecrosis of the jaw is also caused by an inherited disease: osteopetrosis. This review analyzes the biomedical and social aspects of these four situations associated with jaw osteonecrosis.


RESULTS
Clinical evidence is contradictory but suggests aminobisphosphonates cause rare cases of jaw necrosis. In addition to jaw problems, generalized skeletal defects characterize osteopetrosis and exposure to phosphorus or radium and there is evidence of decreased bone resorption in these conditions and with bisphosphonate therapy.


CONCLUSIONS
Bisphosphonate-induced jaw necrosis appears to be an on-target toxicity as the same mechanism, inhibition bone resorption, probably underlies both the therapeutic and adverse effects. Since bisphosphonates are retained for long periods by bone the theoretical potential for skeletal toxicity is increased by using higher doses of potent aminobisphosphonates administered less frequently.
Vance
Michael A
MA
Department of Pharmaceutical Sciences, Butler University, College of Pharmacy and Allied Health Sciences, Indianapolis, Indiana 46208, USA. mvance@butler.edu
D000818:Animals; D001862:Bone Resorption; D004164:Diphosphonates / Q000009:adverse effects*; D004195:Disease Models, Animal; D004285:Dogs; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000473:pathology; D010020:Osteonecrosis / Q000139:chemically induced* / Q000473:pathology; D010022:Osteopetrosis / Q000473:pathology*; D010758:Phosphorus / Q000009:adverse effects*; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology; D011883:Radium / Q000009:adverse effects*
D004164:Diphosphonates; D010758:Phosphorus; D011883:Radium