Bisphosphonates and osteonecrosis of the jaw--current thoughts

Abstract

Bisphosphonates are increasingly being used in a number of bone conditions, including osteoporosis and metastatic cancer. As a consequence, the reported cases of bisphosphonate-related osteonecrosis of the jaw (BONJ) have increased. BONJ remains rare in patients being treated for osteoporosis, but is commoner in cancer patients where the bisphosphonate doses are much higher and mode of delivery is intravenous. Recently, much more is known about classification and mode of action of the bisphosphonates. The potency of the various nitrogen-containing bisphosphonates is dependent on a number of factors including bone binding, zeta potential and inhibition of the enzyme farnesyl pyrophosphate synthase. There is current debate on why BONJ affects the jaw, particularly in relation to whether the jaw has high bone turnover or not. More is being learnt about the micro-organisms involved in the pathogenesis of BONJ and there is increasing evidence on the role of surgical treatment of this disabling condition.

Clinical relevance: Dentists should be aware of the association of bisphosphonates and BONJ. This paper provides recent knowledge on bisphosphonate action, pathogenesis of BONJ and its treatment.