Hyperbaric oxygen treatment and bisphosphonates induced osteonecrosis of the jaw. Onjbp is the correct term, recently emerged, to describe a significant complication in a subset of patients receiving drugs such as zoledronic acid, pamidronate, and alendronate. Rarely found in the jaws is a steroidinduced form of osteonecrosis that is much more common in long bones, and, unlike the bisphosphonateinduced necrotic bone, it almost never produces exposed bone. Although bps improve bone mineral density, reduce fracture risk, and reduce hypercalcemia of malignancy, some patients develop bp. Among cancer patients receiving highdose intravenous bisphosphonates, osteonecrosis of the jaw is dependent on dose and duration of therapy, 17 20 and has an estimated incidence of 1% to 12%. Jul 28, 2007 the actions of the commonly prescribed oral bisphosphonates are discussed. Nih funding opportunities and notices in the nih guide for grants and contracts. Oral and intravenous bisphosphonate induced osteonecrosis. The present study describes a model of maxillary osteonecrosis in spraguedawley rats, applying bisphosphonates and examines the changes occurring after tooth extraction.
Pathophysiology of bisphosphonates associated osteonecrosis of the jaw r01 pa072. Medicationrelated osteonecrosis of the jaw2014 update. Bisphosphonates is a group of inorganic pyrophosphates analogues that suppress bone resorption by inducing osteoclast inactivation, being. Osteonecrosis of the jaws associated with bisphosphonate therapy was first identified in 2003 as a condition typified by exposed bone that does not heal after 8 weeks. Oral and intravenous bisphosphonateinduced osteonecrosis. Oral bisphosphonate related osteonecrosis of the jaw. In the case of malignant diseases, bisphosphonates are usually given intravenously to manage hypercalcemia and bone metastases, such as. In the presence of bp accumulation capable of decreasing bone metabolism, tissue repair following an induced or a physiological trauma does not occur properly. Drug induced osteonecrosis of the jaws bauer smiles dionj. Surgical management of bisphosphonate induced osteonecrosis. Bisphosphonate induced osteonecrosis of the jaw a new disease with possible orthopedic implications there is an alarming new pathologic entity recently recognized in the jaws, which is reminiscent and comparable to osteoradionecrosis orn. Bisphosphonaterelated osteonecrosis of the jaw in patients with osteoporosis. Bisphosphonates have an important role in the prophylaxis and treatment of postmenopausal and corticosteroid osteoporosis.
Therefore there is a move being proposed to call this surgical complication druginduced osteonecrotic jaw or simply osteonecrotic jaw onj. Osteonecrosis of the jaw onj is a rare but serious drug induced adverse event, mainly associated with the use of antiresorptive medications, such as intravenous iv bisphosphonates bps in. Other important risk factors for the development of osteonecrosis include local infection, chemotherapy, steroid use, trauma, and periodontal disease. Oral and intravenous bisphosphonateinduced osteonecrosis of the jaws. Oral bisphosphonates and the risk for osteonecrosis of the. Imaging findings in bisphosphonateinduced osteonecrosis of the jaws katarina surlan popovic1, miha kocar2 1 department of neuroradiology, institute of radiology, university medical centre ljubljana, ljubljana, slovenia 2 department of maxillofacial and oral surgery, university medical centre ljubljana, ljubljana, slovenia received 26 may 2010.
This form of osteonecrosis has been termed bisphosphonate induced osteonecrosis of the jaw bionj. Osteonecrosis of the jaw and bisphosphonates the bmj. Bisphosphonatesrelated osteonecrosis of the jaw in cancer patients and hyperbaric oxygen therapy. Bisphosphonates bps are medications used commonly to treat primary and metastatic bone cancer, as well as osteoporosis. Medicationrelated osteonecrosis of the jaw oral surgery, oral. Periapical disease and bisphosphonates induce osteonecrosis. One centres on the bisphosphonate induced osteoclast inhibition and the other explains the. Bisphosphonates, osteonecrosis of jaw, bisphosphonate related osteonecrosis of jaw. However, a causeandeffect relationship has not been established, and most of the reported cases have been in patients with cancer who were receiving much higher doses than those used to treat osteoporosis or paget disease of bone. Patients undergoing treatment with bisphosphonates may develop jaw lesions consisting mainly of bone necrosis. Oral surgical intervention and female gender increase the risk of the disease. Prospective study of 80 patients with multiple myeloma and other malignancies thacharot boonyapakorn a, ingrid schirmer a, peter a. Although the exact mechanism of bisphosphonateinduced osteonecrosis of the jaw bronj has not yet been determined, several hypotheses have been.
While many clinicians currently recognize that bisphosphonate usage is. A diagnosis of bisphosphonateassociated osteonecrosis of the jaw relies on three criteria. Periapical disease and bisphosphonates induce osteonecrosis of the jaws in mice. Bisphosphonates or other druginduced osteonecrosis of the. The actions of the commonly prescribed oral bisphosphonates are discussed. Fda and interested pharmaceutical companies have been. Imaging findings in bisphosphonateinduced osteonecrosis.
The aim of this study was to detail the clinical efficacy of lowlevel laser therapy lllt for the management of bisphosphonateinduced osteonecrosis of the jaws onjbp. Further research is needed to increase knowledge about the underlying mechanisms and risk factors for onj, and about. However, there are several adverse effects associated with oral bisphosphonates including the bisphosphonate related osteonecrosis of the jaw bronj. Bisphosphonates and osteonecrosis of the jaws australian. Drug induced osteonecrosis of the jaws is bone exposure or infection of the jaw resulting from a side effect of one of several drugs. Osteonecrosis of the jaws by intravenous bisphosphonates and. Medicationrelated osteonecrosis of the jaw wikipedia. The aim of this study was to describe the incidence and risk factors of onj in patients with breast cancer or gynecological malignancies receiving bisphosphonates bp. It also shows that there is an increase in cases of bisphosphonates induced steonecrosis of the jaws in patients using longterm oral preparations, which upports the hypothesis of a cumulative effect of these products involved in disease pathogenesis. This case report presents a patient who presented to the ent department with sinus symptoms from oroantral fistulae following bisphosphonate use requiring surgery. Periodontal disease and bisphosphonates induce osteonecrosis. Since 2003, multiple cases of bisphosphonateinduced osteonecrosis of the jaw onj were reported. The groups of patients most likely to present in primary care with an oral bisphosphonate associated osteonecrosis of the. Imaging findings in bisphosphonateinduced osteonecrosis of.
Osteonecrosis and osteoradionecrosis of the jaws introduction bisphosphonate treatment for malignant diseases or osteoporosis is common. Bisphosphonate bp induced osteonecrosis of the jaws is a rare complication of bisphosphonates bp therapy. However, despite this evidence, many patients at risk for osteoporosis are not screened or treated. Mar 29, 2008 osteonecrosis of the jaws associated with bisphosphonate therapy was first identified in 2003 as a condition typified by exposed bone that does not heal after 8 weeks. Strategies to minimise the risk of osteonecrosis of the jaws with bisphosphonates are unclear. Page 1 medicationrelated osteonecrosis of the jaw 2014 update.
These drugs are employed for the treatment of osteoclastmediated bone diseases, which include osteoporosis, steroidinduced osteoporosis, pagets disease, tumorassociated osteolysis, multiple myeloma, and malignancies associated with hypercalcemia. The frequency of osteonecrosis of the jaws associated with dental implants is unknown. American association of oral and maxillofacial surgeons. Ruggiero, dmd, md, clinical professor, division of oral and maxillofacial surgery, stony brook school of dental medicine, hofstra north shorelij school of medicine, new york center for orthognathic and maxillo. Todays bisphosphonateinduced osteonecrosis represents the second epidemic of phossy jaw. History, etiology, prevention, and treatment, 2nd edition epub format while many clinicians currently recognize that bisphosphonate usage is associated with osteonecrosis of the jaws.
An update on bisphosphonaterelated osteonecrosis of the jaw. Bisphosphonate associated osteonecrosis of the jaw. Dental care protocols bisphosphonate medications are linked to a risk of osteonecrosis of the jaw. Bisphosphonatesinduced osteonecrosis of the jaws core.
Effect of lowlevel laser irradiation on bisphosphonate. Osteonecrosis of the jaws by intravenous bisphosphonates. It is important to note that there are now additional drugs that have been implicated in the development of osteonecrosis of the jaw onj. Guidelines for the diagnosis of bisphosphonaterelated. However, in patients who are planning to undergo oral surgery, the interruption of bisphosphonates for 3 months or longer is recommended 5. Endodontic implications of bisphosphonateassociated. Rarely found in the jaws is a steroid induced form of osteonecrosis that is much more common in long bones, and, unlike the bisphosphonate induced necrotic bone, it almost never produces exposed bone. Since this disease has no independent code in either of the diseases or in the medical procedures classifications, it is. Position paper on bisphosphonaterelated osteonecrosis of the jaw2009 update. Pamidronate aredia and zoledronate zometa induced avascular necrosis. Oral and intravenous bisphosphonateinduced osteonecrosis of. History, etiology, prevention, and treatment, second edition robert e.
Evidence has emerged that bisphosphonate use in cancer patients is associated with osteonecrosis of the jaw. Imaging findings of bisphosphonateassociated osteonecrosis. Database analysis of the risk factors of bisphosphonate. Reichart a, isrid sturm b, gero massenkeil b a department of oral surgery and dental radiology, center of dental medicine, charite. Bisphosphonates are potent inhibitors of osteoclastic bone resorption and one of the most frequently prescribed drugs. Pdf bisphosphonateinduced osteonecrosis of the jaw.
Osteonecrosis of the jaws is a major complication associated with long. Osteonecrosis of the jaws and bisphosphonates springerlink. Lang1,3 1vorarlberg institute for vascular investigation and treatment, feldkirch, austria 2private university of the principality of liechtenstein, triesen, principality of liechtenstein. Medicationrelated osteonecrosis of the jaw in patients with. Bisphosphonateassociated osteonecrosis of the jaws there is growing recognition that bisphosphonates may be associated with a rare adverse event called osteonecrosis of the jaws onj. The value of bisphosphonates resides in their ability to inhibit bone resorption. Pdf bisphosphonates bps are boneremodeling inhibitors that are used to manage bone metastases and osteoporosis. Bisphosphonates and osteonecrosis of the jaws journal of. Pdf bisphosphonateinduced osteonecrosis of the jaws. It also shows that there is an increase in cases of bisphosphonatesinduced steonecrosis of the jaws in patients using longterm oral preparations, which upports the hypothesis of a cumulative effect of these products involved in disease pathogenesis. Oral and intravenous bisphosphonate induced osteonecrosis of.
Various forms of onj have been described over the last 160 years, and a number of causes have been suggested in the literature. Bisphosphonates, drugs that decrease bone turnover by inhibiting osteoclastmediated bone resorption, are used to treat osteoporosis, paget disease, pain from osseous metastases, and malignancyrelated hypercalcemia. The definition is exposed bone, in a patient who has not had head or neck radiation or any metastatic disease, in which the. The controversy of osteonecrosis of the jaws and bisphosphonates is a recent and growing problem. Bisphosphonates are fairly safe drugs to be used in the long term. Care guidelines are based on expert opinion but clinical decisions are left up to practitioners. Jun 12, 2019 pamidronate aredia and zoledronate zometa induced avascular necrosis of the jaws. The following protocols have been developed by the bc cancer agency department of oral oncology. Medicationrelated osteonecrosis of the jaw mronj is a rare, but potentially serious, adverse.
Since intravenous administration leads to a higher drug exposure than the oral route, osteonecrosis related to oral bisphosphonate therapy is less common than that of related to intravenous forms such as zolendronate which is also more potent than oral bisphosphonates. Medicationrelated osteonecrosis of the jaw2014 update special committee on medication related osteonecrosis of the jaws. Bisphosphonate associated osteonecrosis of the jaws there is growing recognition that bisphosphonates may be associated with a rare adverse event called osteonecrosis of the jaws onj. Bisphosphonates and osteonecrosis of the jaw bisphosphonate medications are linked to a risk of osteonecrosis of the jaw. Pathophysiology of bisphosphonatesassociated osteonecrosis of the jaw r01 pa072. Osteonecrosis of the jaw in patients treated with bisphosphonates is a. Just as an extraction requires bone turnover to heal, dental implants require bone turnover to maintain osseointegration. Endodontic implications of bisphosphonateassociated osteonecrosis of the jaws the guidance in this statement is not intended to substitute for a clinicians independent judgment in light of the conditions and needs of a specific patient.
Bisphosphonaterelated osteonecrosis of the jaw scielo. Medicationrelated osteonecrosis of the jaw in patients. Bionj is commonly precipitated by a tooth extraction in patients treated with long term, potent, high dose intravenous bisphosphonates for the management of. Bisphosphonateinduced avascular osteonecrosis of the jaws. Oral bisphosphonate associated osteonecrosis of the jaws. While osteonecrosis can arise from other precipitating conditions, bisphosphonate. Updates on bisphosphonates and potential pathobiology of.
The aim of this study was to detail the clinical efficacy of lowlevel laser therapy lllt for the management of bisphosphonate induced osteonecrosis of the jaws onjbp. Medicationrelated osteonecrosis of the jaw mronj, which was first described in 2002, is a relatively uncommon but potentially serious side effect of treatment with osteoclast inhibitors, such as intravenous highpotency bisphosphonates and denosumab, which decrease the risk of skeletalrelated events in patients with cancer and metastatic bone disease. Osteonecrosis of the jaw and bisphosphonates putting the. Imaging findings in bisphosphonate induced osteonecrosis of the jaws katarina surlan popovic1, miha kocar2 1 department of neuroradiology, institute of radiology, university medical centre ljubljana, ljubljana, slovenia 2 department of maxillofacial and oral surgery, university medical centre ljubljana, ljubljana, slovenia received 26 may 2010. Bionj is commonly precipitated by a tooth extraction in patients treated with long term, potent, high dose intravenous bisphosphonates for the management of myeloma, breast or prostate. Although onj is most common after tooth extractions in patients receiving high.
Oral bisphosphonates are the most commonly prescribed antiresorptive drugs for the treatment of osteoporosis. Objective bisphosphonaterelated osteonecrosis of the jaw bronj is a rare but serious side effect of bisphosphonates bps. Task force on bisphosphonaterelated osteonecrosis of the jaws. Further research is needed to increase knowledge about the underlying. Pamidronate aredia and zoledronate zometa induced avascular necrosis of the jaws. A complication of their use is osteonecrosis of the jaw. In conclusion, is necessary to know this condition for an early diagnosis and treatment, so to prevent its apparition.
Bisphosphonateinduced osteonecrosis of the jaw onj. The groups of patients most likely to present in primary care with an. Oral and intravenous bisphosphonate induced osteonecrosis of the jaws. Drug related risk factors a bisphosphonate potency. M arx 8 defines bisphosphonate induced osteonecrosis of the jaws as a condition characterized by exposure of bone in the mandible or maxilla persisting for more than 8 weeks in a patient who has taken or currently is taking a bisphosphonate and who has no history of radiation therapy to the jaws. Diagnosis if exposed bone is present in the maxillofacial region for more than 8 weeks in the absence of radiotherapy to the jaw in a patient who has been on bisphosphonate therapy, the diagnosis can be confirmed clinically. Osteonecrosis of the jaws associated with the use of bisphosphonates. Osteonecrosis of the jaw onj is a severe bone disease osteonecrosis that affects the jaws the maxilla and the mandible.