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Review
. 2015 Feb;94(2):252-60.
doi: 10.1177/0022034514560768. Epub 2014 Dec 4.

Diabetes as a risk factor for medication-related osteonecrosis of the jaw

A Peer  1 , M Khamaisi  2
Affiliations
Review

Diabetes as a risk factor for medication-related osteonecrosis of the jaw

A Peer et al. J Dent Res. 2015 Feb.

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a severe devastating complication for which the exact pathogenesis is not completely understood. Multiple systemic and local factors may contribute to the development of MRONJ. A growing body of evidence supports diabetes mellitus (DM) as an important risk factor for this complication; however, the exact mechanism by which DM may promote MRONJ has yet to be determined. The current review elucidates the role of DM in the pathogenesis of MRONJ and the mechanisms by which DM may increase the risk for MRONJ. Factors related to DM pathogenesis and treatment may contribute to poor bone quality through multiple damaged pathways, including microvascular ischemia, endothelial cell dysfunction, reduced remodeling of bone, and increased apoptosis of osteoblasts and osteocytes. In addition, DM induces changes in immune cell function and promotes inflammation. This increases the risk for chronic infection in the settings of cancer and its treatment, as well as antiresorptive medication exposure, thus raising the risk of developing MRONJ. A genetic predisposition for MRONJ, coupled with CYP 450 gene alterations, has been suggested to affect the degradation of medications for DM such as thiazolidinediones and may further increase the risk for MRONJ.

Keywords: angigenesis; bone remodeling; diabetes complications; immune responses; inflammation; microvascular disease.

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Conflict of interest statement

The authors received no financial support and declare no potential conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Figure.
Figure.
Role of diabetes in the pathogenesis of medication-related osteonecrosis of the jaw (MRONJ).
See this image and copyright information in PMC

References

    1. AAOMS. (2014). Position paper on medication-related osteonecrosis of the jaw [accessed 2014 Oct 30]. http://www.aaoms.org/docs/position_papers/mronj_position_paper.pdf?pdf=M...
    1. Allegra A, Alonci A, Penna G, Granata A, Nastro Siniscalchi E, Oteri G, Loddo S, Teti D, Cicciù D, De Ponte FS, et al. 2010. Bisphosphonates induce apoptosis of circulating endothelial cells in multiple myeloma patients and in subjects with bisphosphonate-induced osteonecrosis of the jaws. Acta Haematol. 124(2):79–85. - PubMed
    1. Allen MR, Burr DB. 2009. The pathogenesis of bisphosphonate-related osteonecrosis of the jaw: so many hypotheses, so few data. J Oral Maxillofac Surg. 67(5 Suppl):61–70. - PubMed
    1. Aragon-Ching JB, Ning YM, Chen CC, Latham L, Guadagnini JP, Gulley JL, Arlen PM, Wright JJ, Parnes H, Figg WD, et al. 2009. Higher incidence of osteonecrosis of the jaw (ONJ) in patients with metastatic castration resistant prostate cancer treated with anti-angiogenic agents. Cancer Invest. 27(2):221–226. - PMC - PubMed
    1. Aspriello SD, Zizzi A, Lucarini G, Rubini C, Faloia E, Boscaro M, Tirabassi G, Piemontese M. 2009. Vascular endothelial growth factor and microvessel density in periodontitis patients with and without diabetes. J Periodontol. 80(11):1783–1789. - PubMed

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