The position paper was developed by a task force appointed by the board and composed of clinicians with extensive experience in caring for these patients and basic science researchers. Surgeons aaoms position paper on bisphosphonaterelated osteonecrosis of the jaws position paper and approved by the board of trustees in september 2006 1. Download pdf what we know bisphosphonate bp treatment is typically the first medicine used for patients with osteoporosis to slow the breakdown of bone and reduce the chance of fractures. Lack of association between oral bisphophonates and osteonecrosis of the jaw using jaw surgery as a surrogate. This is a smoldering, longterm, destructive process in the jawbone that is often very difficult or impossible to eliminate. Pdf bisphosphonate associated osteonecrosis of the jaw. However, the evidence for bronj in paediatric patients is scarce.
Risks of bisphosphonate use fpins clinical inquiries. Oral bisphosphonate use and the prevalence of osteonecrosis. Pharmacogenetics of bisphosphonateassociated osteonecrosis of the jaw francesca marini1, paolo tonelli2, loredana cavalli1, tiziana cavalli1, laura masi1, alberto falchetti1, maria luisa brandi 1 1department of internal medicine, university of florence, medical school, viale pieraccini 6, 509 florence, italy, 2department of odontostomatology, unive rsity of florence, medical. Please use one of the following formats to cite this article in your essay, paper or report. How cancer patients can lower the risk of bisphosphonate. The special committee favors the term medicationrelated osteonecrosis of the jaw mronj. Therapy for bisphosphonaterelated osteonecrosis of the jaw. Medicationrelated osteonecrosis of the jaw2014 update. Guidelines for the diagnosis of bisphosphonaterelated. Condition bisphosphonates, like alendronate fosamax, description care management tips osteonecrosis of the jaw onj is a condition where the jawbone is exposed and not covered by gums.
Denosumab and zoledronic acid for patients with postmenopausal osteoporosis 5 interventions and comparators one study 17 examined the use of subcutaneous denosumab after oral alendronate compared to continuing on alendronate therapy while another study 18 examined the use of intravenous zoledronic acid after alendronate. These cases occurred in patients with cancer receiving highdose intravenous bp. The patients had exposure of areas of alveolar bone, mostly after oral surgery, eg, mucogingival flap elevation. The aim of this paper is to summarize different diagnostic criteria as well as probable aetiopathogenesis of bisphosphonates related osteonecrosis of the jaw. Lowdose bisphosphonate use in patients with osteoporosis or other metabolic bone disease has not been causally linked to the development of osteonecrosis of.
Raj sindwani, md, facs, frcs bisphosphonaterelated osteonecrosis of the jaw bronj is reported in up to 18. Axial and coronal computed tomography ct images of the maxillofacial bones figures 2 and 3 demonstrate extensive cortical destruction, osteosclerosis, cortical thickening, and fragmentation of the right maxilla, which extends into the frontal process of the zygomatic bone and pterygoid plates. Raj sindwani, md, facs, frcs bisphosphonate related osteonecrosis of the jaw bronj is reported in up to 18. Since this initial identification, many cases have been reported 811. Guidelines for bisphosphonateassociated osteonecrosis of the jaw. There is no test to measure onj risk, but some factors are known to raise this risk in very rare. Bisphosphonaterelated osteonecrosis of the skull base. Guidelines for bisphosphonateassociated osteonecrosis of. Bon is diagnosed in a patient who dhas an area of exposed jaw bone that persists for more than eight weeks. Expert panel recommendations for the prevention, diagnosis, and treatment of osteonecrosis of the jaws.
Decisions to stop or continue bisphosphonate treatment after 5 years 3 years for zoledronate. Feb 26, 2019 please use one of the following formats to cite this article in your essay, paper or report. Bisphosphonateassociated osteonecrosis bon is a rare complication that almost exclusively affects the jaws. Learningradiology bisphosphonaterelated, osteonecrosis. Zoledronic acid aclasta is a newer bisphosphonate administered intravenously onceyearly. Among cancer patients receiving highdose 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%. Oral bisphosphonate induced osteonecrosis is a rare but real entity that is less frequent, less severe, more predictable, and more responsive to treatment than intravenous bisphosphonate induced osteonecrosis. Pdf bisphosphonates bps are boneremodeling inhibitors that are used to manage bone metastases and osteoporosis.
Medicationrelated osteonecrosis of the jaw radiology. Intravenous regimes are designed to treat the complications of. Cloudbased multicenter data collection and epidemiologic. Osteonecrosis of the jaw is typically associated with trauma to the jaw tooth extraction, history of malignancy andor infections while on bisphosphonate therapy.
Multiple myeloma and iv bisphosphonate are risk factors for. Bisphosphonateassociated osteonecrosis of the jaw bon is a rare but serious condition that can cause severe damage to the jaw bone. May 16, 20 despite the benefits of these drugs, bisphosphonate related osteonecrosis of the jaw bronj which was first published in the literature in 2003 is a severe side effect of bisphosphonate therapy 47. Medicationrelated osteonecrosis of the jaw mon, mronj is progressive death of the jawbone in a person exposed to a medications known to increase the risk of disease, in the absence of a previous radiation treatment.
Bisphosphonate use has been described in children diagnosed with osteogenesis imperfecta oi, fibrous dysplasia, neuromuscular disorders, bone dysplasia, idiopathic juvenile osteoporosis. The morning fasting serum cterminal telopeptide bone suppression marker is a. Recently, osteonecrosis affecting only the jaw bones, or osteonecrosis of the jaw onj, has been described as a unique complication secondary to bisphosphonate bp therapy and is thought to represent a growing trend. Bisphosphonaterelated osteonecrosis of the skull base aayesha m. American association of oral and maxillofacial surgeons. Reclast zolendronic acid is a bisphosphonate infusion that has also become more common. Bisphosphonaterelated osteonecrosis of the jaw onj is characterized by nonhealing exposed bone in the maxillofacial region in patients who have undergone bisphosphonate treatment. Diagnostic tissue sampling may exacerbate the process and is. Some studies show shortterm bisphosphonate treatment may slow, improve or prevent bone collapse in the hip or knee. Oral bisphosphonate related osteonecrosis of the jaw.
The prevalence of onj associated with osteoporosis, which is typically treated with a less powerful oral bisphosphonate, has been estimated as less than 1 in 100,000 patient treatment years, with a varied reported prevalence between 0. November 20 dentalupdate 733 oralsurgery the risk of bisphosphonaterelated osteonecrosis of the jaw in children. Blue arrows point to a large lytic lesion in the right side of the mandible in a patient who had been on highdose bisphosphonates for multiple myeloma. Multiple myeloma and iv bisphosphonate are risk factors. Osteonecrosis of the jaw in a patient receiving bisphosphonate therapy. Bisphosphonates are associated with a small risk of osteonecrosis of the. Bisphosphonate for bone cancer is given intravenously every 2 to 4 weeks. The risk of bisphosphonate related osteonecrosis of the jaw.
Characteristics of bisphosphonate related osteonecrosis of the jaw bronj. Pdf background bisphosphonates are antiresorptive agents that have been used for more than a decade, for the treatment of metabolic. Endodontic implications of bisphosphonateassociated. It should also be noted that, although less common, the maxilla can also be affected 7. It may lead to surgical complication in the form of impaired wound healing following oral and maxillofacial surgery. The impact of osteonecrosis of the jaw on osteoporosis management. Drug related risk factors a bisphosphonate potency. Bisphosphonate drug holidays can be considered for patients who have persisted with bisphosphonate therapy for 3 to 5 years and for those at low risk of fracture. Pharmacogenetics of bisphosphonate associated osteonecrosis of the jaw francesca marini1, paolo tonelli2, loredana cavalli1, tiziana cavalli1, laura masi1, alberto falchetti1, maria luisa brandi 1 1department of internal medicine, university of florence, medical school, viale pieraccini 6, 509 florence, italy. Since intravenous administration leads to a higher drug exposure than the oral route, osteonecrosis related to oral bisphosphonate therapy is less common than that of related to intravenous forms such as zolendronate which is also more potent than oral bisphosphonates. This is alleged to increase the oxygen supply to the body tissue and stop necrosis. The american society for bone and mineral research defines bronj as an area of exposed bone in the maxillofacial region that has not healed within 8 weeks after identification.
Risk factors, prediction of risk using serum ctx testing, prevention, and treatment robert e. Osteonecrosis of the jaw in patients with bone metastases treated with bisphosphonates. Article bisphosphonate associated osteonecrosis of the jaw. Medicationrelated osteonecrosis of the jaw wikipedia. Hyperbaric oxygen in addition to antibiotic therapy is effective for bisphosphonate induced osteonecrosis of the jaw in a patient with multiple myeloma. Given the widespread use of bisphosphonates in clinical practice, even a very low incidence of oral osteonecrosis in bisphosphonate users should be considered a public emergency. It is recommended that you have a good dental exam prior to starting these medications.
Pharmacogenetics of bisphosphonateassociated osteonecrosis. Medicationrelated osteonecrosis of the jaw guidance for the oncology multidisciplinary team 6 mronj in the adjuvant setting the frequency of mronj from oral bisphosphonates in the early breast cancer setting is 0. The risk of bisphosphonate related osteonecrosis of the. Bisphosphonate associated osteonecrosis is a rare clinical entity that is poorly understood. Bisphosphonateassociated osteonecrosis is a rare clinical entity that is poorly understood. Bisphosphonates are associated with a small risk of atypical femoral shaft fractures, which increases with duration of use. Pain from hip or knee osteonecrosis may be worse during weightbearing or walking. Despite these benefits, osteonecrosis of the jaws has.
Hyperbaric osteonecrosis pdf utility of hyperbaric oxygen in treatment of bisphosphonate related osteonecrosis of the jaws. Bisphosphonate related osteonecrosis of the jaw bronj was the initially described entity, but mronj is now the preferred term as other medications besides bisphosphonates have been implicated as etiological agents 5,6. Bisphosphonate length of treatment in osteoporosis. Antiresorptive agents, especially the bp zoledronic acid or zometa and the nonbp denosumab or xgeva, prolia are used to prevent the spread of cancers to. Nov 16, 2010 bisphosphonate associated osteonecrosis bon is a rare complication that almost exclusively affects the jaws. Bisphosphonate associated osteonecrosis of the jaw the. Bisphosphonates bps are a class of drugs used to treat osteoporosis and malignant bone metastasis. Bisphosphonates for treatment of osteoporosis expected beneits, potential harms, and drug holidays. Most cases are managed by oral surgeons with only a handful of.
Medicationrelated osteonecrosis of the jaw mronj, which was first described in 2002, is a relatively uncommon but potentially serious side effect of treatment with osteoclast inhibitors, such as intravenous highpotency bisphosphonates and denosumab, which decrease the risk of skeletalrelated events in patients with cancer and metastatic bone disease. Pdf bisphosphonateinduced osteonecrosis of the jaw. The first case reports describing a possible relationship between bisphosphonate therapy and osteonecrosis of the jaw published in the journal of endodontics and the journal of the american dental association termed the phenomenon as bisphosphonate associated osteonecrosis of the jaw or bonj. Bisphosphonate related osteonecrosis of the skull base aayesha m. The first case reports describing a possible relationship between bisphosphonate therapy and osteonecrosis of the jaw published in the journal of endodontics and the journal of the american dental association termed the phenomenon as bisphosphonateassociated osteonecrosis of the. The underlying etiology is unclear and may be multifactorial. Bps show high binding capacity to the bone matrix, especially in sites of active bone metabolism. To assess the risk and time course of oral bisphosphonateinduced osteonecrosis of the jaws.
It may also occur spontaneously without having had any recent. Bon has only been recognized within the past 10 years. Bisphosphonate associated osteonecrosis of the jaw. It may lead to surgical complication in the form of impaired wound healing following oral and maxillofacial surgery, periodontal surgery, or endodontic therapy. Bisphosphonate associated osteonecrosis of the jaw bon is a rare but serious condition that can cause severe damage to the jaw bone. Surgeons aaoms position paper on bisphosphonate related osteonecrosis of the jaws position paper and approved by the board of trustees in september 2006 1. Bisphosphonate use and the risk of adverse jaw outcomes. Bisphosphonaterelated osteonecrosis of the jaw rev bras reumatol 2012. The decision to discontinue oral bisphosphonate drug therapy before dental treatment should be made by you in consultation with your medical doctor.
The prevalence of onj is variable and has been reported to be 1%10% in patients receiving intravenous bisphosphonate treatment for cancer. From the molecular viewpoint, bps are postulated to modulate the function of osteoclasts, reacting with a surface receptor or with an intracellular enzyme. Osteonecrosis of the jaw in patients treated with bisphosphonates is a relatively rare but well known complication at maxillofacial units around the world. Bisphosphonaterelated osteonecrosis of the jaws bronj was first. Bisphosphonateassociated osteonecrosis of the jaw ncbi.
It has been speculated that the medication, especially longterm i. Bisphosphonate related osteonecrosis of the jaw bronj has become an increasingly common complication as the use of these drugs is becoming more widespread in adults. Bisphosphonate related osteonecrosis of the jaw onj is characterized by nonhealing exposed bone in the maxillofacial region in patients who have undergone bisphosphonate treatment. Bisphosphonaterelated osteonecrosis of the jaw bronj is characterized by delayed healing or nonhealing of the bone and soft tissue following an oral surgery procedure such as tooth extraction, dental implant placement, periapical surgery and some periodontal surgeries. Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw. June 2004 background osteonecrosis of the jaws is a rare potential complication in cancer patients receiving radiation, chemotherapy, or other cancer treatment regimens, or in patients with tumorsinfectious embolic events. Therapy for bisphosphonaterelated osteonecrosis of the. Bisphosphonates are a class of agents used to treat osteoporosis and malignant bone metastases. Bisphosphonateinduced osteonecrosis of the ear canal. Endodontic implications of bisphosphonate associated osteonecrosis of the jaws the guidance in this statement is not intended to substitute for a clinicians independent judgment in light of the conditions and needs of a specific patient.
1147 989 781 1597 388 1513 43 376 163 864 391 409 318 611 536 324 1530 787 894 274 1073 482 1299 1482 161 1209 293 1312 1339 154 679 1360 284 666 1135 115 58