title: Bisphosphonate associated osteonecrosis of the jaw.
abstract: In 2003, the first reports describing osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BP) were published. These cases occurred in patients with cancer receiving high-dose intravenous BP; however, 5% of the cases were in patients with osteoporosis receiving low-dose bisphosphonate therapy. We present the results of a systematic review of the incidence, risk factors, diagnosis, prevention, and treatment of BP associated ONJ. We conducted a comprehensive literature search for relevant studies on BP associated ONJ in oncology and osteoporosis patients published before February 2008.All selected relevant articles were sorted by area of focus. Data for each area were abstracted by 2 independent reviewers. The results showed that the diagnosis is made clinically. Prospective data evaluating the incidence and etiologic factors are very limited. In oncology patients receiving high-dose intravenous BP, ONJ appears to be dependent on the dose and duration of therapy, with an estimated incidence of 1%-12% at 36 months of exposure. In osteoporosis patients, it is rare, with an estimated incidence < 1 case per 100,000 person-years of exposure. The incidence of ONJ in the general population is not known. Currently, there is insufficient evidence to confirm a causal link between low-dose BP use in the osteoporosis patient population and ONJ. We concluded BP associated ONJ is associated with high-dose BP therapy primarily in the oncology patient population. Prevention and treatment strategies are currently based on expert opinion and focus on maintaining good oral hygiene and conservative surgical intervention.
authors.affiliation: Divisions of Endocrinology and Geriatrics, McMaster University, Oakville, ON L6J 1X8, Canada. avkhan@aol.com
authors.forename: Aliya A
authors.initials: AA
authors.lastname: Khan
authors.forename: George K B
authors.initials: GK
authors.lastname: Sándor
authors.forename: Edward
authors.initials: E
authors.lastname: Dore
authors.forename: Archibald D
authors.initials: AD
authors.lastname: Morrison
authors.forename: Mazen
authors.initials: M
authors.lastname: Alsahli
authors.forename: Faizan
authors.initials: F
authors.lastname: Amin
authors.forename: Edmund
authors.initials: E
authors.lastname: Peters
authors.forename: David A
authors.initials: DA
authors.lastname: Hanley
authors.forename: Sultan R
authors.initials: SR
authors.lastname: Chaudry
authors.forename: Brian
authors.initials: B
authors.lastname: Lentle
authors.forename: David W
authors.initials: DW
authors.lastname: Dempster
authors.forename: Francis H
authors.initials: FH
authors.lastname: Glorieux
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Neville
authors.forename: Reena M
authors.initials: RM
authors.lastname: Talwar
authors.forename: Cameron M
authors.initials: CM
authors.lastname: Clokie
authors.forename: Majd Al
authors.initials: MA
authors.lastname: Mardini
authors.forename: Terri
authors.initials: T
authors.lastname: Paul
authors.forename: Sundeep
authors.initials: S
authors.lastname: Khosla
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.forename: Susan
authors.initials: S
authors.lastname: Sutherland
authors.forename: David K
authors.initials: DK
authors.lastname: Lam
authors.forename: Robert P
authors.initials: RP
authors.lastname: Carmichael
authors.forename: Nick
authors.initials: N
authors.lastname: Blanas
authors.forename: David
authors.initials: D
authors.lastname: Kendler
authors.forename: Steven
authors.initials: S
authors.lastname: Petak
authors.forename: Louis Georges
authors.initials: LG
authors.lastname: Ste-Marie
authors.forename: Jacques
authors.initials: J
authors.lastname: Brown
authors.forename: A Wayne
authors.initials: AW
authors.lastname: Evans
authors.forename: Lorena
authors.initials: L
authors.lastname: Rios
authors.forename: Juliet E
authors.initials: JE
authors.lastname: Compston
mesh_terms: D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D009369:Neoplasms / Q000150:complications; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D010024:Osteoporosis / Q000517:prevention & control; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates