Bisphosphonate-associated osteonecrosis of the jaw

Abstract

The term 'osteonecrosis of the jaw' is typically used to describe the exposure of bone within the oral cavity. These lesions are often painful and can result in pathological fracture and disfigurement in severe cases. Infection and dental extractions commonly precede presentation, although lesions can occur spontaneously. There are no clear effective management strategies; surgery often makes the situation worse. The aetiology is far from clear. Historically, it was mainly associated with exposure to 'white phosphorus' contained in safety matches. More recently, it has presented as a complication of head and neck radio-therapy. The vast majority of contemporary reports refer to high-dose intravenous bisphosphonates used in the oncological setting. However, oral bisphosphonates, for the common indication of postmenopausal osteoporosis, have also been implicated, although the number of cases is minuscule considering the number of worldwide prescriptions. Osteonecrosis of the jaw poses a significant problem in oncology, but whether this worry is transferable to metabolic bone disease only time will tell. Certainly, further research into its pathophysiology and management is merited. With regard to management of postmenopausal osteoporosis, practice should not necessarily be altered at this early stage; however, pre-treatment worries regarding dental health should perhaps instigate a precautionary dental review.