title: Bisphosphonates, vitamin D, parathyroid hormone, and osteonecrosis of the jaw. Could there be a missing link?
abstract: BACKGROUND
  It is estimated that over 190 million bisphosphonates have been prescribed worldwide. But this drug can produce adverse effects, of which osteonecrosis of the jaw and severe hypocalcemia are the most serious. It is evident that bisphosphonate administration affects multiple and diverse biochemical mediators related to bone metabolism.
  
  
  METHODS
  This review of literature investigates four basic parameters in patients treated with bisphosphonates - parathyroid hormone (PTH), bisphosphonates, vitamin D, calcium, and jaw osteonecrosis - which are fundamental for assessing bone metabolism and so the efficacy and correct use of the drug. The imbalances generated by vitamin D and calcium deficiencies, together with their multiple systemic repercussions, have been widely researched but the outcomes of these imbalances in relation to bisphosphonate administration are not well known, and some research has indicated that they may be associated with osteonecrosis of the jaw (ONJ).
  
  
  RESULTS
  The present review set out to explain the functioning of bone metabolism, the importance of different chemical mediators, the imbalances produced by incorrect use of this drug, in order to forewarn against the possible relation of these parameters with ONJ, whose physiopathology remains unknown.
  
  
  CONCLUSIONS
  Medical and dental clinics should keep detailed anamneses of the use of vitamin D and calcium supplements, as it is of vital importance to maintain their correct levels in blood, given that these are related to ONJ as well as other adverse effects; this procedure is also necessary in order to ensure the correct use of the drug.
authors.affiliation: Department of Special Care in Dentistry,Faculty of Dentistry, University of Granada, Colegio Máximo s/n, E18071, Granada, Spain, ggomez@ugr.es.
authors.forename: Ignacio-Osoitz
authors.initials: IO
authors.lastname: Leizaola-Cardesa
authors.forename: Antonio
authors.initials: A
authors.lastname: Aguilar-Salvatierra
authors.forename: Maximino
authors.initials: M
authors.lastname: Gonzalez-Jaranay
authors.forename: Gerardo
authors.initials: G
authors.lastname: Moreu
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sala-Romero
authors.forename: Gerardo
authors.initials: G
authors.lastname: Gómez-Moreno
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology*; D004164:Diphosphonates / Q000009:adverse effects*; D006801:Humans; D010281:Parathyroid Hormone / Q000009:adverse effects*; D014807:Vitamin D / Q000009:adverse effects*
chemical_list: D004164:Diphosphonates; D010281:Parathyroid Hormone; D014807:Vitamin D
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