Therapy for bisphosphonate-related osteonecrosis of the jaw: A systematic review

Abstract

Bisphosphonates are usually prescribed for treating metabolic and neoplastic bone disorders. Intravenous bisphosphonate formulations containing nitrogen are the ones most often associated with osteonecrosis of the jaw. The available therapies range from conservative procedures to invasive procedures. The literature was systematically reviewed to determine the therapies available and their efficacy. Related studies published originally in any language from January 2003 to April 2017 and indexed in the MEDLINE (National Library of Medicine) and Cochrane databases were analyzed. The following phrases were searched: "Bisphosphonate-Associated Osteonecrosis of the Jaw" OR "Bisphosphonate Osteonecroses" OR "Bisphosphonate Osteonecrosis" OR "Bisphosphonate- Induced Osteonecrosis of the Jaw" OR "Bisphosphonate-Related Osteonecrosis of the Jaw" AND "treatment" OR "therapy" OR "therapeutics" OR "treatment outcome." The inclusion criteria were randomized controlled clinical trials, pertinent retrospective studies, systematic reviews, and meta-analyses. The levels of evidence of the studies were assessed independently by two referees, experts in the area. This review confirms that the therapeutic approaches are based only on expert recommendations and opinions. Hence, preventive guidelines are mandatory because there is no gold standard in the therapy of bisphosphonate-related osteonecrosis of the jaw.