Bisphosphonate-induced osteonecrosis of the jaw: A review of 2,400 patient cases

Abstract

Purpose Bisphosphonates (BPs) are bone-remodeling inhibitors that are used to manage bone metastases and osteoporosis. Osteonecrosis of the jaw, however, can occur during treatment. This complication is poorly understood and is called "bisphosphonate-induced osteonecrosis of the jaw"(BIOJ). Methods We performed a PubMed-based review of all of the described cases of BIOJ from January 2003 (the year of the first description) to September 2009. Issues of clinical relevance, such as the primary diagnosis and type of treatment, were evaluated for each patient case. Results We retrieved 2,408 cases, 88% of which were associated with intravenous therapy, primarily withzoledronate. Of the total number of cases, 89% wereassociated with the treatment of a malignant condition,particularly multiple myeloma (43% of the cases). Of all the BIOJ cases, 67% were preceded by tooth extraction andonly 35% of patients were cured.Conclusion Prevention is better than treatment, and the establishment of meticulous oral hygiene and surgicalprocedures prior to commencing BP treatment is important for preventing BIOJ. Our review summarizes the currentknowledge about this severe complication. Future studies,especially basic research studies, are needed to better understand this devastating disease. © Springer-Verlag 2010.