Current knowledge and future directions on bisphosphonate-related osteonecrosis of the jaw in cancer patients.
BACKGROUND
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a severe adverse event of long-term use of bisphosphonates that heavily affects the quality of life of cancer patients.


OBJECTIVE
To review epidemiologic data, pathobiology, risk factors, diagnosis and management of BRONJ.


METHODS
Articles were identified by searching the PubMed and MEDLINE databases and recent meetings abstracts.


CONCLUSIONS
BRONJ pathobiology is thought to be related to bisphosphonate-induced suppression of normal bone remodeling and impairment of bone blood flow. Dental extractions, daily masticatory traumas, oral infections, chemotherapy and antiangiogenic drugs can also play an active role. Collaboration between oncologists and dentists is essential to prevent BRONJ. A conservative approach based on pain control, oral rinses, antibiotics and limited debridement represents the current management. Optimization of therapy based on reduction of bisphosphonate doses or exposure time, newer bisphosphonates and biomolecular agents could favorably impact on BRONJ incidence.
Adamo
Vincenzo
V
Policlinico Universitario G. Martino, Department of Human Pathology, Medical Oncology and Integrated Therapies Unit, Messina, Italy. vadamo@unime.it
Caristi
Nicola
N
Saccà
Marcello Maugeri
MM
Ferraro
Giuseppa
G
Arcanà
Concetta
C
Maisano
Roberto
R
Santini
Daniele
D
Tonini
Giuseppe
G
D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy; D016723:Bone Remodeling / Q000187:drug effects; D001842:Bone and Bones / Q000098:blood supply / Q000187:drug effects; D003937:Diagnosis, Differential; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D010020:Osteonecrosis / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D012307:Risk Factors
D050071:Bone Density Conservation Agents; D004164:Diphosphonates