Osteonecrosis de los maxilares asociada a bifosfonatos: Revisión sistemática

Abstract

In the last years a new complication has been described in the therapy with biphosphonates: biphosphonateassociated osteonecrosis of the jaws. This complication had not been detected in previous clinical tests. In this systematic review of 340 cases, the patients had as primary diagnosis principally: multiple myeloma (51.2%), breast cancer (31.4%), prostate cancer (7.1%) and osteoporosis (4.1%). The mandible is more affected than the maxilla, with 59.1%. The relationship between femenine and masculine gender was 2:2.6. The pamidronate was the biphosphonate more associated to the cases of osteonecrosis (35.3%). The risk factors associated include: use of biphosphonates, presence of oral infections, trauma, oral surgical procedures and therapies against cancer (chemoterapy, corticosteroids and other cytostatics agents). Effects on bone turnover, antiangiogenic property of biphosphonates, inhibitory effect of biphosphonates on the keratinocyte cell cycle and osteolysis mechanisms induced in the bacterial infection could explain the etiological mechanisms in the development of this complication.