REVIEW - Osteohemonecrosis of the jaws due to bisphosphonate treatments. Update.

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Med Oral Patol Oral Cir Bucal. 2008 May 1;13(5):E318-24.

Osteochemonecrosis of the jaws due to bisphosphonate treatments. Update.

Gómez Font R, Martínez García ML, Olmos Martínez JM.

Oral Surgery Program, European University at Madrid, Madrid, Spain.

Comment in:

Med Oral Patol Oral Cir Bucal. 2009 Jan;14(1):E1-2.

Bisphosphonates (BP),were initially used in industry and later as a

drug due to their great affinity to osseous tissue, because of their

powerful antiresorptive effect as a treatment in various osteopathies,

such as osteoporosis, Paget disease or hypercalcemia associated with

some malignant tumors, as myeloma or breast cancer. They are

administered orally or intravenously, and although well tolerated, the

most frequent side effects are gastrointestinal, in addition to

osteonecrosis when they are administered via endovenous. The aim of

this work has been to evaluate the existing publications in accredited

scientific literature on biphosphonates and their action mechanism and

the relationship with the appearance of osteonecrosis of the jaws.

Although the mechanism by which osteonecrosis of the jaws develops is

not known exactly, there seems to be influence by osteoclast

inhibiton, antiangiogenic action, an inhibitory effect on the cellular

cycle by the keratinocytes, as well as, reinforcement of the

chemiotoxic action in oncological patients treated with other drugs.

Clinically, it ranges from a non-specificity of symptoms to lesions

such as osteomyelitis with necrosis and osseous sequesters that may be

accompanied by fetor ex oris, with the appearance of many Actinomyces

contaminated lesions. As for published antecedents on osteonecrosis

due to bisphosphonate treatment found until 2006: 46.5% had a previous

diagnosis of multiple myeloma; 38.8% were patients with metastatic

breast cancer; 6.2% patients of metastatic prostate cancer; 4.1%

suffered from osteoporosis; 3.5% from other metastatic diseases and

0.8% had Paget disease.

The drugs that seem to have the highest incidence of

osteochemionecrosis are: zoledronate, pamidronate, alendronate,

risendronate and ibandronate, from the greatest to the least.

Additionally, the risk of osteonecrosis being produced is accumulative

and may reach 21% in the third year of intravenous bisphosphonate use.

PMID: 18449117

http://www.ncbi.nlm.nih.gov/pubmed/18449117

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