Diagnóstico, prevención y tratamiento de la osteonecrosis de los maxilares por bisfosfonatos. Recomendaciones de la Sociedad Española de Cirugía Oral y Maxilofacial (SECOM)

Abstract

The bisphosphonates are stable inorganic pyrophosphate analogs that have demonstrated their efficacy in the treatment of a variety of pathologies, such as osteolytic lesions associated with bony metastases or multiple myeloma, malignant hypercalcemia, Paget's disease, and osteoporosis. Currently, two disease entities supported by different degrees of scientific evidence can be characterized, at least academically: osteonecrosis associated with intravenous bisphosphonate administration and osteonecrosis associated with oral bisphosphonate administration. Prevention and treatment strategies are being consolidated for jaw necrosis associated with intravenous bisphosphonate use, but more scientific documentation is needed for the condition associated with oral bisphosphonate use. Our aim is to facilitate the clinical and complementary diagnosis of bisphosphonate associated osteonecrosis by oral health specialists (oral and maxillofacial surgeons, dentists, and stomatologists). The objectives of the present article were to describe the most appropriate preventive measures for limiting the number of cases of this pathology in the light of current knowledge, to detail the best recognized form of treatment for different stages of jaw osteonecrosis, and, for established jaw osteonecrosis, to describe good medical and dentistry practice for patients who suffer this disease or are at risk of suffering it. This document was approved by the SECOM Scientific Commission. © 2008 ergon.