Consideration for treatment of bisphosphonate-related osteonecrosis of the jaw

Kyung-Ha You; Kyu-Ho Yoon; Jung-Ho Bae; Jae-An Park; Gun-Chan Park; Jae-Myung Shin; Jee-Seon Baik; Jeong-Kwon Cheong

doi:10.5125/jkaoms.2010.36.3.206

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You, Yoon, Bae, Park, Park, Shin, Baik, and Cheong: Consideration for treatment of bisphosphonate-related osteonecrosis of the jaw

Original Article

J Korean Assoc Oral Maxillofac Surg 2010;36(3):206-210.

Published online: 10 January 2010

DOI: https://doi.org/10.5125/jkaoms.2010.36.3.206

Consideration for treatment of bisphosphonate-related osteonecrosis of the jaw

Kyung-Ha You¹, Kyu-Ho Yoon¹, Jung-Ho Bae¹, Jae-An Park¹, Gun-Chan Park¹, Jae-Myung Shin², Jee-Seon Baik², Jeong-Kwon Cheong¹

¹Department of Oral and Maxillofacial Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea

²Department of Oral and Maxillofacial Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea

Jeong-Kwon Cheong Department of Oral and Maxillofacial Surgery, Inje University Sanggye-Paik Hospital 761-1, Sanggye 7dong, Nowon-gu, Seoul, 139-707, Korea TEL: +82-2-950-1161 FAX: +82-2-950-1167 E-mail: dentpd@paik.ac.kr

Received 22 March 2010 Revised 31 April 2010 Accepted 20 May 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bisphosphonates are widely used to treat osteoporosis, hypercalcemia of malignant tumor. Despite their clinical benefit, bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a newly documented complication to patients receiving these drugs and first recognized by Marx in 2003. Thus, consideration of prevention and needs regarding unequivocal treatment regimen have emerged. Recently, several authors emphasized reports on appropriate clinical availability of surgical approach. It serves to concern about guideline for surgical and conservative treatment modalities. So, it is the purpose of this paper to review the current literatures about treatment regimens of BRONJ.

Keywords: Bisphosphonate, Osteonecrosis, Osteoporosis

References

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Table 1.

Staging and treatment strategies

Stage	Description	Treatment Strategies
At risk category	No apparent necrotic bone	No treatment indicated
At risk category		Patient education
Stage 0	No clinical evidence of necrotic bone, non-specific clinical findings and symptoms	Systemic management, including use of pain medication and antibiotics
Stage 1	Exposed and necrotic bone in patients who are asymptomatic and have no infection	Antibacterial mouth rinse
		Clinical follow up on quarterly basis
		Patient education and review of indications for continues bisphosphonate therapy
Stage 2	Exposed and necrotic bone associated with infection as evidenced by pain and erythema in region of exposed bone with or without purulent drainage	Symptomatic treatment with oral antibiotics
		Pain control
		Antibacterial mouth rinse
		Superficial debridement to relieve soft tissue irrigation
Stage 3	Exposed and necrotic bone in patients with pain, infection, and one or more of the following: exposed and necrotic bone extending beyond the region of alveolar bone (inferior border and ramus in the mandible, maxillary sinus and zygoma in the maxilla) resulting in pathologic fracture, extraoral fistula, oral antral/oral nasal communication, or osteolysis extending to the inferior border of the mandible or the sinus floor	Antibacterial mouth rinse
		Antibiotic therapy and pain control
		Surgical debridement/resection for longer term palliation of infection and pain

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