Osteonecrosis caused by bisphosphonates

As a side effect, jaw’s osteonecrosis was recorded for the first time in 2003 bibliography.

Bisphosphonates are a group of medicines that, due to their osteolytic effect, are considered the first choice of medicines for patients who suffer from osteoporosis and osteopenia because they reduce the danger of an osteoporotic fracture by 50%.

They are also administered to patients with multiple myeloma, cancer at breast, prostate, kidney, lung and when there are bone metastases.

Also, they are administered for the Paget bone disease treatment and the imperfect osteogenesis. Bisphosphonates, nowadays, are frequently prescribed medicines by doctors of various specialties like rheumatologists, orthopedists, endocrinologists, oncologists, pathologists.

Most commonly administered bisphosphonates include:

  • Zoledronate (Zometa)
  • Ibandronate (Bonviva)
  • Risedronate (Actonel)
  • Pamidronate (Aredia)
  • Alendronate (Fosamax)

 

Bisphosphonates are administered either intravenously or from the mouth. The probability for them to cause jaw osteomyelitis or osteonecrosis is increased if they are received from the mouth for more than 3 years or if they are received intravenously for more than 6 months. Generally, the danger of jaw osteonecrosis is much higher when the patient receives the bisphosphonate intravenously.

Osteonecrosis caused by bisphosphonates is more frequent at the lower jaw and usually a dental operation like a tooth extraction has been preceded. During osteonecrosis, there is a decomposition of the mucous membrane and revelation of the necrotic bone which may be asymptomatic or painful. Every patient who receives bisphosphonates in any way must maintain a very high level of oral hygiene.

It is good to avoid executing any intraoral operations (like extractions) to these patients, but if it is necessary, it is considered deliberate to stop receiving the medicine 3 months before and 3 months after the operation. The treatment for osteomyelitis by bisphosphonates is extremely difficult.

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