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Review
. 2016;45(7):20160049.
doi: 10.1259/dmfr.20160049. Epub 2016 May 31.

Bisphosphonate-related osteonecrosis of the jaw: from the sine qua non condition of bone exposure to a non-exposed BRONJ entity

Valesca Sander Koth  1 , Maria Antonia Figueiredo  1 , Fernanda Gonçalves Salum  1 , Karen Cherubini  1
Affiliations
Review

Bisphosphonate-related osteonecrosis of the jaw: from the sine qua non condition of bone exposure to a non-exposed BRONJ entity

Valesca Sander Koth et al. Dentomaxillofac Radiol. 2016.

Abstract

The present work aimed to review the literature focusing on the diagnostic criteria for bisphosphonate-related osteonecrosis of the jaw (BRONJ) and its implications regarding the management of the disease. Since the report of the first cases, BRONJ concepts, diagnostic criteria and guidelines have been changed. The presence of bone exposure in the oral cavity was at first a sine qua non condition for diagnosis. However, it seems that the great concern now is the possibility of occurrence of BRONJ without this feature. Some authors warn that the bone exposure criterion leads to late diagnosis and poor response to treatment. Meanwhile, some radiographic features, such as bone sclerosis, have been postulated as early signs of the disease. Criticisms have also been raised about the clinical staging system of BRONJ. While there is no consensus on the subject, common sense recommends treating symptomatic patients taking bisphosphonate as having BRONJ despite the absence of bone exposure; and asymptomatic patients must be kept under dental follow-up, since all of them are at risk for BRONJ.

Keywords: MRI; bisphosphonate-related osteonecrosis of the jaw; osteonecrosis; radiography; tomography.

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Figures

Figure 1
Figure 1
Non-exposed bisphosphonate-related osteonecrosis of the jaw in a 58 year-old female patient under sodium alendronate therapy and subjected to dental implant surgery. (a) Clinical examination shows no bone exposure or fistula tract. (b) Panoramic radiography shows generalized alteration of bone density and osteolysis extending from the dental implant area to the inferior border of the mandible (arrows). (c–e) CBCT shows diffuse osteolysis also in the anterior region of the mandible. (f–h) CBCT shows bone reorganization 16 months after starting antibiotic therapy.
Figure 2
Figure 2
Exposed bisphosphonate-related osteonecrosis of the jaw in a 61-year-old female patient under sodium alendronate therapy and subjected to tooth extraction. (a) Clinical examination shows two areas of bone exposure in the mandible (arrows); (b) a close-up of bone exposure (arrow). (c) Panoramic radiography shows diffuse osteolysis with bone sclerosis in the mandible. (d) CBCT shows diffuse osteolysis with bone sclerosis and disruption of the cortical bone.
Figure 3
Figure 3
Management of non-exposed bisphosphonate-related osteonecrosis of the jaw. Patients previously or currently subjected to bisphosphonate therapy should be clinically and radiographically evaluated and accordingly managed with antibiotic therapy and/or clinical radiographic follow-up.
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References

    1. Greenberg MS. Intravenous bisphosphonates and osteonecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 98: 259–60. doi: http://dx.doi.org/10.1016/j.tripleo.2004.08.001 - DOI - PubMed
    1. McClung M, Harris ST, Miller PD, Bauer DC, Davison KS, Dian L, et al. . Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med 2013; 126: 13–20. doi: http://dx.doi.org/10.1016/j.amjmed.2012.06.023 - DOI - PubMed
    1. Sun K, Liu JM, Sun HX, Lu N, Ning G. Bisphosphonate treatment and risk of esophageal cancer: a meta-analysis of observational studies. Osteoporos Int 2013; 24: 279–86. doi: http://dx.doi.org/10.1007/s00198-012-2158-8 - DOI - PubMed
    1. Schilcher J, Koeppen V, Aspenberg P, Michaëlsson K. Risk of atypical femoral fracture during and after bisphosphonate use. Acta Orthop 2015; 86: 100–7. doi: http://dx.doi.org/10.3109/17453674.2015.1004149 - DOI - PMC - PubMed
    1. Sharma A, Chatterjee S, Arbab-Zadeh A, Goyal S, Lichstein E, Ghosh J, et al. . Risk of serious atrial fibrillation and stroke with use of bisphosphonates: evidence from a meta-analysis. Chest 2013; 144: 1311–22. doi: http://dx.doi.org/10.1378/chest.13-0675 - DOI - PubMed

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