Bisphosphonate associated osteonecrosis of the jaw.
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.
Khan
Aliya A
AA
Divisions of Endocrinology and Geriatrics, McMaster University, Oakville, ON L6J 1X8, Canada. avkhan@aol.com
Sándor
George K B
GK
Dore
Edward
E
Morrison
Archibald D
AD
Alsahli
Mazen
M
Amin
Faizan
F
Peters
Edmund
E
Hanley
David A
DA
Chaudry
Sultan R
SR
Lentle
Brian
B
Dempster
David W
DW
Glorieux
Francis H
FH
Neville
Alan J
AJ
Talwar
Reena M
RM
Clokie
Cameron M
CM
Mardini
Majd Al
MA
Paul
Terri
T
Khosla
Sundeep
S
Josse
Robert G
RG
Sutherland
Susan
S
Lam
David K
DK
Carmichael
Robert P
RP
Blanas
Nick
N
Kendler
David
D
Petak
Steven
S
Ste-Marie
Louis Georges
LG
Brown
Jacques
J
Evans
A Wayne
AW
Rios
Lorena
L
Compston
Juliet E
JE
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
D050071:Bone Density Conservation Agents; D004164:Diphosphonates