Why does bisphosphonates cause osteonecrosis of the jaw?
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is thought to be caused by trauma to dentoalveolar structures that have a limited capacity for bone healing due to the effects of bisphosphonate therapy. See the image below. Exposed, necrotic bone in the left anterior maxilla.
How common is osteonecrosis of the jaw with bisphosphonates?
Among cancer patients receiving high-dose 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%.
Which osteoporosis medication causes osteonecrosis of the jaw?
Bisphosphonates — such as alendronate (Fosamax, Binosto), risedronate (Actonel, Atelvia), ibandronate (Boniva) and zoledronic acid (Reclast, Zometa) — and denosumab (Prolia, Xgeva) have been linked to osteonecrosis of the jaw and atypical femoral fractures.
How common is osteonecrosis of the jaw with Fosamax?
The overall incidence of bisphosphonate-related osteonecrosis of the jaws is low, ranging from 0.7% to 12%, mainly observed in those patients receiving intravenously treatment. Osteonecrosis of the jaws associated to oral bisphosphonate, particularly alendronate, has also been reported by a number of authors.
How can you prevent bisphosphonate related osteonecrosis of the jaw?
Conclusions: Preventive oral and maxillofacial treatment before bisphosphonate application combined with 3-monthly dental follow-ups significantly reduces the occurrence and risk of BRONJ in PC patients.
How long does it take for osteonecrosis of the jaw to develop?
Osteonecrosis of the jaw is diagnosed when exposed, necrotic bone is present in the maxilla or mandible for at least 8 weeks.
What medication most commonly cause osteonecrosis?
What are the most commonly used drugs that cause MRONJ?
- Bisphosphonate Medications: Fosamax, Actonel, Boniva and Zometa.
- Antibody Agonist Medications (RANK ligated inhibitor Denosumab): Prolia and Xgeva.
- Antiagiogenic Medications.
- Other unknown drugs might also be involved in causing MRONJ.
How do you know if you have osteonecrosis of the jaw?
Symptoms of ONJ can range from very mild to severe. ONJ looks like an area of exposed bone in your mouth. It can cause tooth or jaw pain and swelling in your jaw. Severe symptoms include infection in your jaw bone.
Why do bisphosphonates cause MRONJ?
Several studies have proposed that bisphosphonates cause excessive reduction of bone turnover, resulting in a higher risk of bone necrosis when repair is needed. It is also thought that bisphosphonates bind to osteoclasts and interfere with the remodeling mechanism in bone.
What kind of doctor treats osteonecrosis of the jaw?
Because osteonecrosis of the jaw is challenging to treat, an oral surgeon with experience treating it should be consulted. Treatment of osteonecrosis of the jaw typically involves scraping away some of the damaged bone, taking antibiotics by mouth, and using mouth rinses.
What is the best bisphosphonate for osteoporosis?
We suggest either alendronate or risedronate as the initial choice of bisphosphonate (Grade 2B). Individuals with well-controlled gastroesophageal reflux or peptic ulcer disease can also take alendronate or risedronate.
How is osteonecrosis of the jaw treated?
What is the treatment for ONJ? Mild cases of ONJ can be treated with a mouth wash. More severe cases can be treated with antibiotics, topical gels (gels you put directly on your gums), and dental procedures.
What is bisphosphonate-related osteonecrosis of the jaw?
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is defined as the exposure of the bone in the maxillofacial region more than 8 weeks in patients who are under bisphosphonate treatment without any radiation treatment, and who have a previous dental surgery including dental implant placement ( 4, 5 ).
What causes osteonecrosis of the jaw?
Osteonecrosis of the jaw can occur in patients who are not taking bisphosphonates and in patients without traditional risk factors. Diagnosis
Does bisphosphonate affect osteointegration of dental implants?
There’s no clear relationship between bisphosphonate and osteointegration of dental implants. Bisphosphonates increase mechanical stability of implants if used locally and at the same time increase the risk of osteonecrosis of the jaw if used systemically. Bisphosphonates have different effects on bone repair sites and bone remodeling sites.
Do bisphosphonates increase the risk of BRONJ?
7 patients had signs and symptoms of BRONJ, during the first 3 years of bisphosphonate usage since they were taking corticosteroids as a co-adjunctive treatment, which also increased the toxicity of bisphosphonates.