Bisphosphonate-induced osteonecrosis of the jaw: a medical enigma?
Bisphosphonates are used for the standard of care of patients with skeletal metastases and hypocalcemia of malignancy. Bisphosphonate-induced osteonecrosis (BION) is a serious complication. Clinically, BION presents as an area of exposed alveolar bone that occurs spontaneously or becomes evident following an invasive surgical procedure such as extraction of a tooth, periodontal surgery, apicoectomy, or oral implant placement. The mechanism by which bisphosphonates cause osteonecrosis is uncertain. There are no controlled trials to show a direct cause-effect relationship between bisphosphonates and osteonecrosis of the jaw. Oral bisphosphonate-induced necrosis is a rare clinical entity, less frequent, less aggressive, more predictable, and more responsive to treatment than IV forms of bisphosphonate-related osteonecrosis of the jaw. However, there have been reports of this complication with the less potent oral forms of bisphosphonates (0.007% to 0.01%). The morbidity of osteonecrosis of the jaw induced by IV bisphosphonates is significant, so prevention should receive prime importance. Patients should receive prophylactic dental examinations, and any necessary dental treatment before starting bisphosphonate therapy. Good communication among dentists, oral surgeons, physicians, and oncologists is of vital importance in providing care of these patients.
Siddiqi
Allauddin
A
Oral Implantology Research Group, Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand. siddiqidr@gmail.com
Payne
Alan G T
AG
Zafar
Sobia
S
D000284:Administration, Oral; D000539:Alveolar Process / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016723:Bone Remodeling / Q000187:drug effects; D003729:Dental Care; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007275:Injections, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced* / Q000517:prevention & control; D019647:Oral Surgical Procedures; D010020:Osteonecrosis / Q000139:chemically induced* / Q000517:prevention & control; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D012307:Risk Factors
D050071:Bone Density Conservation Agents; D004164:Diphosphonates