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Factors associated with osteonecrosis of the jaw among bisphosphonate users

Lisa M Hess1, Joanne M Jeter, Marge Benham-Hutchins

  • 1College of Medicine, Arizona Cancer Center, University of Arizona, Tucson, AZ 85724-5024, USA. hess@u.arizona.edu

The American Journal of Medicine
|May 27, 2008
PubMed
Abstract

Insights

Osteonecrosis of the jaw (ONJ) can occur in patients taking bisphosphonates for non-cancer reasons. Multiple factors, including dental procedures and other medications, contribute to ONJ risk in these patients.

Area of Science:

  • Oral and Maxillofacial Surgery
  • Pharmacology
  • Bone Biology

Background:

  • Bisphosphonates inhibit osteoclast function, impacting bone remodeling.
  • Osteonecrosis of the jaw (ONJ) is a known complication associated with bisphosphonate therapy.
  • Risk factors for ONJ in cancer patients on bisphosphonates may differ from those in non-cancer patients.

Purpose of the Study:

  • To identify potential contributing factors for osteonecrosis of the jaw (ONJ) in patients using bisphosphonates for non-cancer indications.
  • To develop an expanded model for understanding ONJ mechanisms in patients without a cancer diagnosis.

Main Methods:

  • Systematic review of cases of ONJ in patients taking bisphosphonates for non-cancer reasons.
  • Analysis of identified cases using established models to create a more comprehensive explanatory model.

Main Results:

  • Ninety-nine cases of ONJ were identified in patients treated with bisphosphonates for non-cancer conditions (e.g., osteoporosis, Paget's disease).
  • Most patients were older females on oral bisphosphonates, with a high incidence of prior dental procedures.
  • A significant percentage of patients had concurrent medications affecting bone turnover and underlying health conditions.

Conclusions:

  • The development of ONJ in patients on bisphosphonates for non-cancer indications is multifactorial.
  • A proposed model outlines potential mechanisms for ONJ in this patient population.

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