Bisphosphonate-related osteonecrosis of the jaw: current state of the problem

Abstract

The article presents review of the literature on the current state of the problem of bisphosphonate-related osteonecrosis of the jaw. In Russia and abroad there are numerous reports of atypical lesions of the maxilla associated with taking medications on the basis of phosphorus or its analogues, in particular bisphosphonates. This is an issue: if earlier bisphosphonate treatment complications were limited to individual clinical observations, currently their frequency, according to different authors, reaches 8-27%. Bisphosphonate-related osteonecrosis of the jaw is characterized by unique etiopathogenic, clinical and diagnostic features that distinguish it from other inflammatory, degenerative and iatrogenic diseases of orofacial region, so it is reasonable to isolate it into an independent nosology, requiring a comprehensive study. According to current data, bisphosphonate-related osteonecrosis of the jaw is a complication of antiresorptive therapy, characterized by necrosis and exposure of bone area, which persists for more than 8 weeks, followed by the process progression in the absence of radiation therapy to the head area in history. Bisphosphonates are antiresorptive agents, potent inhibitors of bone tissue destruction, widely used for the treatment of bone metastasis, multiple myeloma, and hypercalcemia in cancer patients. However, the development of complications such as osteonecrosis of the jaw greatly reduces the positive effects of treatment, and extremely bothersome for patients. Osteonecrosis-related pyo-inflammatory processes of admaxillary tissue, the appearance of persistent sinus tracts on the skin and in the mouth, the risk of pathologic fracture of the jaw impair the quality of life of patients. Presented in the article analysis of currently known data about the bisphosphonate-related osteonecrosis of the jaw should attract the attention of dental surgeons, maxillofacial surgeons, endocrinologists, oncologists to this problem.