Bisphosphonates and Osteonecrosis of the Jaw - Current Thoughts

From Volume 36, Issue 7, September 2009 | Pages 415-419

Authors

Yazdana Arrain

BDS, DRDP

Clinical Lecturer in Restorative Dentistry, University of Birmingham School of Dentistry, St Chad's Queensway, Birmingham B4 6NN

Articles by Yazdana Arrain

Tahir Masud

MA(Oxon), MBBS(Lond), MSc(Nott), FRCP

Professor of Musculoskeletal Gerontology, University of Derby and Consultant Physician, Nottingham University Hospitals NHS Trust, Hucknell Road, Nottingham, NG5 1PB, UK

Articles by Tahir Masud

Abstract

Bisphosphonates are increasingly being used in a number of bone conditions, including osteoporosis and metastatic cancer. As a consequence, the reported cases of bisphosphonate-related osteonecrosis of the jaw (BONJ) have increased. BONJ remains rare in patients being treated for osteoporosis, but is commoner in cancer patients where the bisphosphonate doses are much higher and mode of delivery is intravenous. Recently, much more is known about classification and mode of action of the bisphosphonates. The potency of the various nitrogen-containing bisphosphonates is dependent on a number of factors including bone binding, zeta potential and inhibition of the enzyme farnesyl pyrophosphate synthase. There is current debate on why BONJ affects the jaw, particularly in relation to whether the jaw has high bone turnover or not. More is being learnt about the micro-organisms involved in the pathogenesis of BONJ and there is increasing evidence on the role of surgical treatment of this disabling condition.

Article

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