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Bisphosphonate-Associated Osteonecrosis

MedGen UID:
458762
•Concept ID:
C2986536
•
Disease or Syndrome
Synonyms: Bisphosphonate Associated Osteonecrosis; Bisphosphonate Osteonecroses; Bisphosphonate Osteonecrosis; Bisphosphonate-Associated Osteonecroses; Osteonecroses, Bisphosphonate; Osteonecroses, Bisphosphonate-Associated; Osteonecrosis, Bisphosphonate; Osteonecrosis, Bisphosphonate-Associated

Definition

Necrosis of the mandible or maxilla in patients receiving intravenous or oral bisphosphonate therapy. It usually manifests with slow healing or failure to heal of a jaw bone following oral surgery. In a minority of cases, the necrosis appears spontaneously. Signs and symptoms include pain, swelling and infection of the affected area. [from NCI]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVBisphosphonate-Associated Osteonecrosis

Professional guidelines

PubMed

Management of bisphosphonate-related osteonecrosis of the jaw using teriparatide treatment: A systematic review.
Varoneckas A, Gelažius R, Pliavga V, Leketas M, Kubilius R, Varoneckaitė M
Stomatologija 2022;24(3):63-70. PMID: 37140255
Role of ozone therapy in the treatment of osteonecrosis of the jaws in multiple myeloma patients.
Petrucci MT, Gallucci C, Agrillo A, Mustazza MC, Foà R
Haematologica 2007 Sep;92(9):1289-90. doi: 10.3324/haematol.11096. PMID: 17768133
Bisphosphonate-associated osteonecrosis: a long-term complication of bisphosphonate treatment.
Migliorati CA, Siegel MA, Elting LS
Lancet Oncol 2006 Jun;7(6):508-14. doi: 10.1016/S1470-2045(06)70726-4. PMID: 16750501

Recent clinical studies

Etiology

American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update.
Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D
J Oral Maxillofac Surg 2022 May;80(5):920-943. Epub 2022 Feb 21 doi: 10.1016/j.joms.2022.02.008. PMID: 35300956
Medication-Related Osteonecrosis of the Jaws.
Migliorati CA, Brennan MT, Peterson DE
J Natl Cancer Inst Monogr 2019 Aug 1;2019(53) doi: 10.1093/jncimonographs/lgz009. PMID: 31425596
Antiresorptive treatment-associated ONJ.
Eleutherakis-Papaiakovou E, Bamias A
Eur J Cancer Care (Engl) 2017 Nov;26(6) Epub 2017 Oct 24 doi: 10.1111/ecc.12787. PMID: 29063702
Safety of bisphosphonates.
Orozco C, Maalouf NM
Rheum Dis Clin North Am 2012 Nov;38(4):681-705. doi: 10.1016/j.rdc.2012.09.001. PMID: 23137577
Antiresorptives and osteonecrosis of the jaw.
Yamashita J, McCauley LK
J Evid Based Dent Pract 2012 Sep;12(3 Suppl):233-47. doi: 10.1016/S1532-3382(12)70046-5. PMID: 23040351

Diagnosis

American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update.
Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D
J Oral Maxillofac Surg 2022 May;80(5):920-943. Epub 2022 Feb 21 doi: 10.1016/j.joms.2022.02.008. PMID: 35300956
Imaging of Radiation- and Medication-Related Osteonecrosis.
Mallya SM, Tetradis S
Radiol Clin North Am 2018 Jan;56(1):77-89. Epub 2017 Oct 10 doi: 10.1016/j.rcl.2017.08.006. PMID: 29157550Free PMC Article
Antiresorptive treatment-associated ONJ.
Eleutherakis-Papaiakovou E, Bamias A
Eur J Cancer Care (Engl) 2017 Nov;26(6) Epub 2017 Oct 24 doi: 10.1111/ecc.12787. PMID: 29063702
Numb chin syndrome: a rare and often overlooked symptom.
Assaf AT, Jürgens TP, Benecke AW, Riecke B, Blessmann M, Zrnc TA, Much CC, Heiland M, Friedrich RE
J Oral Facial Pain Headache 2014 Winter;28(1):80-90. doi: 10.11607/jop.994. PMID: 24482791
Osteoporosis.
Nieves JW, Mosner M, Silverstein S
N Y State Dent J 2012 Jun-Jul;78(4):30-5. PMID: 23252191

Therapy

Bisphosphonates.
Billington E, Aghajafari F, Skulsky E, Kline GA
BMJ 2024 Aug 21;386:e076898. doi: 10.1136/bmj-2023-076898. PMID: 39168493
American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update.
Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D
J Oral Maxillofac Surg 2022 May;80(5):920-943. Epub 2022 Feb 21 doi: 10.1016/j.joms.2022.02.008. PMID: 35300956
Bisphosphonate holidays.
Reid IR
Drug Ther Bull 2021 Mar;59(3):35-36. doi: 10.1136/dtb.2020.000057. PMID: 33627350
Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus.
Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, Langdahl BL, Al Dabagh R, Davison KS, Kendler DL, Sándor GK, Josse RG, Bhandari M, El Rabbany M, Pierroz DD, Sulimani R, Saunders DP, Brown JP, Compston J; International Task Force on Osteonecrosis of the Jaw
J Bone Miner Res 2015 Jan;30(1):3-23. doi: 10.1002/jbmr.2405. PMID: 25414052
Safety of bisphosphonates.
Orozco C, Maalouf NM
Rheum Dis Clin North Am 2012 Nov;38(4):681-705. doi: 10.1016/j.rdc.2012.09.001. PMID: 23137577

Prognosis

Does medication-related osteonecrosis of the jaw affect survival of patients with Multiple Myeloma?: Exploring a large single center database using artificial intelligence.
Bittrich M, Hetterich R, Solimando AG, Krebs M, Loda S, Danhof S, Anton S, Zhou X, Kerscher A, Beilhack A, Kortüm KM, Rasche L, Einsele H, Knop S, Hartmann S
Clin Exp Med 2023 Dec;23(8):5215-5226. Epub 2023 Oct 7 doi: 10.1007/s10238-023-01100-6. PMID: 37805620Free PMC Article
Medication-Related Osteonecrosis of the Jaws.
Migliorati CA, Brennan MT, Peterson DE
J Natl Cancer Inst Monogr 2019 Aug 1;2019(53) doi: 10.1093/jncimonographs/lgz009. PMID: 31425596
Antiresorptives: Safety Concerns-Clinical Perspective.
Brown JP
Toxicol Pathol 2017 Oct;45(7):859-863. Epub 2017 Oct 24 doi: 10.1177/0192623317737066. PMID: 29065818
OSTEONECROSIS OF THE JAW: AN UPDATE FOR DENTISTS.
Morrison A, Khan A, Tetradis S, Peters E
J Can Dent Assoc 2015;81:f19. PMID: 26679333
Numb chin syndrome: a rare and often overlooked symptom.
Assaf AT, Jürgens TP, Benecke AW, Riecke B, Blessmann M, Zrnc TA, Much CC, Heiland M, Friedrich RE
J Oral Facial Pain Headache 2014 Winter;28(1):80-90. doi: 10.11607/jop.994. PMID: 24482791

Clinical prediction guides

Does medication-related osteonecrosis of the jaw affect survival of patients with Multiple Myeloma?: Exploring a large single center database using artificial intelligence.
Bittrich M, Hetterich R, Solimando AG, Krebs M, Loda S, Danhof S, Anton S, Zhou X, Kerscher A, Beilhack A, Kortüm KM, Rasche L, Einsele H, Knop S, Hartmann S
Clin Exp Med 2023 Dec;23(8):5215-5226. Epub 2023 Oct 7 doi: 10.1007/s10238-023-01100-6. PMID: 37805620Free PMC Article
Infection as an Important Factor in Medication-Related Osteonecrosis of the Jaw (MRONJ).
Otto S, Aljohani S, Fliefel R, Ecke S, Ristow O, Burian E, Troeltzsch M, Pautke C, Ehrenfeld M
Medicina (Kaunas) 2021 May 9;57(5) doi: 10.3390/medicina57050463. PMID: 34065104Free PMC Article
OSTEONECROSIS OF THE JAW: AN UPDATE FOR DENTISTS.
Morrison A, Khan A, Tetradis S, Peters E
J Can Dent Assoc 2015;81:f19. PMID: 26679333
Osteochemonecrosis: an overview.
Hellstein J
Head Neck Pathol 2014 Dec;8(4):482-90. Epub 2014 Nov 20 doi: 10.1007/s12105-014-0583-z. PMID: 25409847Free PMC Article
Alendronate-associated osteonecrosis of the jaws: a review of the main topics.
Paiva-Fonseca F, Santos-Silva AR, Della-Coletta R, Vargas PA, Lopes MA
Med Oral Patol Oral Cir Bucal 2014 Mar 1;19(2):e106-11. doi: 10.4317/medoral.19094. PMID: 23986020Free PMC Article

Recent systematic reviews

Medication-related osteonecrosis of the jaw (MRONJ) systemic review: mevalonate pathway mechanisms explored.
Cho J, Feldman G, Tomlinson R, Taub D, Diecidue R
Oral Surg Oral Med Oral Pathol Oral Radiol 2024 Oct;138(4):475-483. Epub 2024 Jun 3 doi: 10.1016/j.oooo.2024.05.014. PMID: 38987158
Bisphosphonate-associated osteonecrosis of the jaw.
Ferreira Jr LH Jr, Mendonça Jr KD Jr, Chaves de Souza J, Soares Dos Reis DC, do Carmo Faleiros Veloso Guedes C, de Souza Castro Filice L, Bruzadelli Macedo S, Soares Rocha F
Minerva Dent Oral Sci 2021 Feb;70(1):49-57. Epub 2020 Sep 22 doi: 10.23736/S2724-6329.20.04306-X. PMID: 32960522
Dental Implant Placement in Patients With a History of Medications Related to Osteonecrosis of the Jaws: A Systematic Review.
Sher J, Kirkham-Ali K, Luo JD, Miller C, Sharma D
J Oral Implantol 2021 Jun 1;47(3):249-268. doi: 10.1563/aaid-joi-D-19-00351. PMID: 32699903
What is the effect of anti-resorptive drugs (ARDs) on the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: A systematic review.
Aljohani S, Fliefel R, Ihbe J, Kühnisch J, Ehrenfeld M, Otto S
J Craniomaxillofac Surg 2017 Sep;45(9):1493-1502. Epub 2017 Jun 3 doi: 10.1016/j.jcms.2017.05.028. PMID: 28687467
Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus.
Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, Langdahl BL, Al Dabagh R, Davison KS, Kendler DL, Sándor GK, Josse RG, Bhandari M, El Rabbany M, Pierroz DD, Sulimani R, Saunders DP, Brown JP, Compston J; International Task Force on Osteonecrosis of the Jaw
J Bone Miner Res 2015 Jan;30(1):3-23. doi: 10.1002/jbmr.2405. PMID: 25414052

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