Oral Bisphosphonate-Induced Osteonecrosis of Jaw: Risk Factors, Prevention, and Treatment Guidelines

Abstract

Patients first diagnosed with osteoporosis are often prescribed a oral bisphosphonate. Bisphosphonates inhibit osteoclastic activity and as a result will compromise the normal healing and remodeling processes within bone. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) adversely affects the quality of life and produces significant morbidity in afflicted patients. Oral and maxillofacial surgeons have been responsible for treating a majority of these patients. There was a direct exponential relationship between the size of the exposed bone and the duration of oral bisphosphonate use. The comorbidities of steroid along with a bispho-sphonate will cause the osteonecrosis to occur sooner, be more severe, and respond more slowly to a drug holiday. In the southern areas of Taiwan, a lot of elders are used to take long-term steroids to the pain or the chronic disease, so the conditions are often relatively serious when patients suffer from BRONJ simultaneously. The Department of Oral and Maxillofacial Surgery of Chang Gung Memorial Hospital-Kaohsiung Memorial Center specifically treat 4 patients who suffered from BRONJ. All of them were obtained good treatment result. From the data gained from studies and our clinical experience with the cases, we offer recommendations of risk factors, prevention, and treatment of BRONJ.