Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Nov;55(1):95-102.
doi: 10.1016/j.jdsr.2018.09.002. Epub 2019 May 17.

Novel insight into the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ)

Hiromitsu Kishimoto  1 , Kazuma Noguchi  1 , Kazuki Takaoka  1
Affiliations
Review

Novel insight into the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ)

Hiromitsu Kishimoto et al. Jpn Dent Sci Rev. 2019 Nov.

Abstract

Bisphosphonate-related osteonecrosis of the jaw (BRONJ), characterized by refractory bone exposure, has recently emerged as a serious side effect of bisphosphonate (BPs) treatment. We discuss novel insights that may help to improve the efficacy of BRONJ treatment and prevention. Our report highlights the following: (1) The presence of exposed bone in patients taking BPs does not necessarily reflect BRONJ, and diagnoses of oral ulceration with bone sequestration and malignancy must be excluded. (2) Osteonecrosis type of BRONJ is difficult to avoid using preventive dental measures alone. However, as with osteomyelitis type of BRONJ, preventive dental measures are indispensable for reducing the risk of secondary infection and disease progression. (3) The importance of tooth extraction as a risk factor for BRONJ among patients taking BPs has been overstated, particularly when they are administered at low doses. Delaying tooth extraction may increase the risk for the onset and progression of osteomyelitic BRONJ. (4) In patients taking low doses of BPs, dental implant surgery is not necessarily contraindicated if there are no other risk factors, such as combined use of corticosteroids or concomitant diabetes. However, the risk of BRONJ due to peri-implantitis must be explained when obtaining patient consent.

Keywords: BRONJ; Bisphosphonates; Jaw; Osteomyelitis; Osteonecrosis; Tooth extraction.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) Typical BRONJ with exposure of the jawbone. (B) Orthopantomogram showing separation of the sequestrum. BRONJ: bisphosphonate-related osteonecrosis of the jaw.
Figure 2
Figure 2
Bilateral BRONJ is difficult to distinguish from OUBS. BRONJ: bisphosphonate-related osteonecrosis of the jaw. OUBS: oral ulceration and benign sequestration/oral ulceration with bone sequestration.
Figure 3
Figure 3
Relationship between osteonecrosis type and osteomyelitis type of BRONJ.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Yoneda T., Hagino H., Sugimoto T., Ohta H., Takahashi S., Soen S. Antiresorptive agent-related osteonecrosis of the jaw: position paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw. J Bone Miner Metab. 2017;35(1):6–19. - PubMed
    1. Khan A.A., Morrison A., Hanley D.A., Felsenberg D., McCauley L.K., O’Ryan F. International task force on osteonecrosis of the jaw. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Mineral Res. 2015;30(1):3–23. - PubMed
    1. Qi W.X., Tang L.N., He A.N., Yao Y., Shen Z. Risk of osteonecrosis of the jaw in cancer patients receiving denosumab: a meta-analysis of seven randomized controlled trials. Int J Clin Oncol. 2014;19:403–410. - PubMed
    1. Marx R.E. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61:1115–1117. - PubMed
    1. Urade M., Tanaka N., Furusawa K., Shimada J., Shibata T., Kirita T. Nationwide survey for bisphosphonate-related osteonecrosis of the jaws in Japan. J Oral Maxillofac Surg. 2011;69:e364–e371. - PubMed

LinkOut - more resources