Bisphosphonates and osteonecrosis of the mandible/maxilla in osteoporosis: no reason to panic.
Bisphosphonate (BP) therapy has modified the natural history of many bone metabolic diseases. Amino-bisphosphonates nowadays represent the primary therapeutic choice for the treatment of osteoporosis and for prevention of fractures. Osteonecrosis of the mandible and maxilla (ONJ) is a rare disease usually occurring in cancer patients with bone metastases treated with high doses of intravenous BPs. Some cases have been described in patients taking amino-BPs for osteoporosis, but the specific drug utilized, its dosage and use of the oral route have reduced that risk considerably (estimated at 1/100,000 subjects a year). Prevention of ONJ include good oral hygiene habits in all patients and, in a subject who has been treated for more than three years, conservative dental procedures when possible, an appropriate antibiotic therapy and a careful follow-up when invasive oral interventions are necessary, are recommended by dentists and bone metabolism experts alike.
Bertoldo
Francesco
F
Unit of Diseases of Mineral Metabolism and of the Bone, Department of Biomedical and Surgical Sciences, University of Verona, 37124 Verona, Italy. francesco.bertoldo@univr.it
D001859:Bone Neoplasms / Q000188:drug therapy; D001842:Bone and Bones / Q000378:metabolism; D011756:Diphosphates / Q000009:adverse effects* / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000517:prevention & control; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced* / Q000517:prevention & control; D010024:Osteoporosis / Q000188:drug therapy*; D012307:Risk Factors
D011756:Diphosphates