Osteonecrosis of the jaw

Area of Science:

• Pharmacology
• Oncology
• Dentistry

Background:

• Bisphosphonates, like etidronate and alendronate, are FDA-approved since 1977 and 1995, respectively, for osteoporosis treatment.
• They are also used for skeletal complications of malignancy, including hypercalcemia and bone metastases.
• Millions of patients have used bisphosphonates long-term.

Purpose of the Study:

• To describe osteonecrosis of the jaw (ONJ), a rare condition associated with bisphosphonate therapy.
• To discuss the incidence, presentation, and management of ONJ.
• To outline preventive strategies for ONJ.

Main Methods:

• Literature review and clinical observation of bisphosphonate-associated osteonecrosis of the jaw (ONJ).
• Analysis of ONJ occurrence in patients receiving oral and intravenous bisphosphonates for osteoporosis and malignancy.
• Review of current treatment and prevention strategies for ONJ.

Main Results:

• Osteonecrosis of the jaw (ONJ) is defined as exposed maxillofacial bone unhealed for 8 weeks, often following dental procedures.
• ONJ incidence is higher in patients receiving high-dose intravenous bisphosphonates for cancer (5-10% over 3 years) compared to oral bisphosphonates for osteoporosis (rare, ~1 per 100,000).
• While a causal link is not definitively proven, ONJ occurs almost exclusively in patients on bisphosphonates; treatment is conservative.

Conclusions:

• Bisphosphonate therapy, while effective for osteoporosis and malignancy, carries a rare risk of osteonecrosis of the jaw (ONJ).
• ONJ management is conservative, focusing on infection control and limited debridement.
• Preventive measures include good dental hygiene and completing invasive dental procedures before high-dose bisphosphonate therapy for cancer.