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[Bisphosphonates and maxillo-mandibular osteo(chemo)necrosis].

M Magremanne1, C Vervaet, L Dufrasne

  • 1Service de Stomatologie et Chirurgie Maxillo-faciale, Cliniques Universitaires de Bruxelles, Belgique. michele.magremanne@hap.be

Revue De Stomatologie Et De Chirurgie Maxillo-Faciale
|December 30, 2006
PubMed
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Bisphosphonate drugs can cause jaw osteonecrosis, particularly in the mandible, due to its exposed nature and vascularization. Dental exams are crucial before prescribing these bone-targeting therapies.

Area of Science:

  • Oral and Maxillofacial Surgery
  • Oncology
  • Pharmacology

Background:

  • Bisphosphonates inhibit osteoclastic activity and are used for hypercalcemia, bone metastases, Paget's disease, and osteoporosis.
  • Maxillomandibular osteonecrosis is rare, typically associated with radiotherapy, but bisphosphonates are an emerging cause.
  • The incidence of bisphosphonate-related osteonecrosis may be underestimated due to a lack of routine dental examinations.

Observation:

  • Six cases of bisphosphonate-associated mandibular necrosis were reviewed.
  • Osteonecrosis occurred spontaneously in two patients, post-extraction in two, and with pre-existing dental infections in two.
  • Histopathology revealed necrotic bone colonized by Actinomyces in all cases.

Findings:

  • The maxillomandibular region is uniquely susceptible to bisphosphonate-induced osteonecrosis.

Related Experiment Videos

  • The mandible's terminal vascularization makes it prone to necrosis, even after minor trauma.
  • Actinomyces colonization is a common histopathological finding in these cases.

    • Implications:

    • Routine dental examinations are recommended prior to initiating bisphosphonate therapy.
    • Awareness of this adverse effect is crucial for clinicians prescribing bisphosphonates.
    • Further research into the pathogenesis and prevention of bisphosphonate-induced osteonecrosis is warranted.