Osteonecrosis of the Jaw — Do Bisphosphonates Pose a Risk?

College of Physicians and Surgeons, Columbia University, New York, USA.
New England Journal of Medicine (Impact Factor: 55.87). 12/2006; 355(22):2278-81. DOI: 10.1056/NEJMp068157
Source: PubMed

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    • "However, most of the reported cases have been related to intravenous use of bisphosphonates (zoledronic and pamidronic acid) to control metastatic bone disease or multiple myeloma. The incidence of ONJ in these studies ranges from 4 to 10% [1, 68, 69] and the mean time of onset varies from 1 to 3 years [55, 70, 71]. "
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    ABSTRACT: Osteonecrosis of the jaw in patients treated with bisphosphonates is a relatively rare but well known complication at maxillofacial units around the world. It has been speculated that the medication, especially long-term i.v. bisphosphonate treatment, could cause sterile necrosis of the jaws. The aim of this narrative review of the literature was to elaborate on the pathological mechanisms behind the condition and also to gather an update on incidence, risk factors, and treatment of bisphosphonate associated osteonecrosis of the jaw. In total, ninety-one articles were reviewed. All were published in internationally recognized journals with referee systems. We can conclude that necrotic lesions in the jaw seem to be following upon exposure of bone, for example, after tooth extractions, while other interventions like implant placement do not increase the risk of osteonecrosis. Since exposure to the bacterial environment in the oral cavity seems essential for the development of necrotic lesions, we believe that the condition is in fact chronic osteomyelitis and should be treated accordingly.
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    • "Oral bisphosphonates are primarily used for prevention and treatment of osteoporosis (Melo and Obeid, 2005) and for treatment of Paget's disease and Osteogenesis Imperfecta in children (Bradford and Airedale NHS, 2007). Intravenous bisphosphonates are widely used for the management of bone disorders such as hypercalcemia associated with malignancy and multiple myeloma (Ficarra et al., 2005; Bilezikian, 2006). Table 1 displays different types of bisphosphonates, their trade names, methods of administration and nitrogen content. "

    Full-text · Dataset · Oct 2013
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    • "[3] Some authors rec‐ ommend performing computed tomography. [33] Chiandussi et al. suggest that later changes in jaw bones in bisphosphonate-associated osteonecrosis can be visualized by radi‐ ography, and for early detection of lesions it is necessary to perform computed tomography examination or MRI. [43] Dunstan et al. recommend jaw bone scintigraphy with Tc-99m methylene diphosphonate. "

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