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osteonecrosis of the jaw

Etiology: - bisphosphonate use in metastatic bone disease - cases due to intravenous bisphosphonates - cases due to oral bisphosphonates less compelling [1,2,3,4,5,6,7] Clinical manifestations: - cormorbid conditions: - osteoporosis - cancer - most commonly affected site is the mandible (62%), followed by the maxilla (23%) [1] - may occur at a the site of a tooth extraction socket - some purulent drainage may be observed - extraoral manifestations [7] - erythematous swelling around the jaw - cutaneous fistulas communicating with the involved bone - in most cases, the mandible (not the maxilla) is involved Differential diagnosis: - necrotizing periodontitis - acute inflammatory process of the periodontium - necrosis or ulcer of the interdental papilla - gingival bleeding, pain, & rapid bone loss - occurs in the presence of teeth, not at the site of tooth extraction

General

osteonecrosis

References

  1. Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2007 Mar;65(3):369-76. PMID: 17307580 http://www.aaoms.org/docs/position_papers/osteonecrosis.pdf - Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, Gagel RF, Gilsanz V, Guise T, Koka S, McCauley LK, McGowan J, McKee MD, Mohla S, Pendrys DG, Raisz LG, Ruggiero SL, Shafer DM, Shum L, Silverman SL, Van Poznak CH, Watts N, Woo SB, Shane E; American Society for Bone and Mineral Research. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007 Oct;22(10):1479-91. PMID: 17663640 http://dx.doi.org/10.1359/JBMR.0707ONJ - Bilezikian JP. Osteonecrosis of the jaw--do bisphosphonates pose a risk? N Engl J Med. 2006 Nov 30;355(22):2278-81. PMID: 17135582 - Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala P. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007 Aug;29(8):1548-58. Review. PMID: 17919538 - Mavrokokki T, Cheng A, Stein B, Goss A. Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia. J Oral Maxillofac Surg. 2007 Mar;65(3):415-23. PMID: 17307586 - Grant BT, Amenedo C, Freeman K, Kraut RA. Outcomes of placing dental implants in patients taking oral bisphosphonates: a review of 115 cases. J Oral Maxillofac Surg. 2008 Feb;66(2):223-30. PMID: 18201600 - Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, Satterfield S, Wallace RB, Bauer DC, Palermo L, Wehren LE, Lombardi A, Santora AC, Cummings SR; FLEX Research Group. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006 Dec 27;296(24):2927-38. PMID: 17190893 - Cartsos VM, Zhu S, Zavras AI. Bisphosphonate use and the risk of adverse jaw outcomes: a medical claims study of 714,217 people. J Am Dent Assoc. 2008 Jan;139(1):23-30. PMID: 18167381 - Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005 Mar;90(3):1294-301. Epub 2004 Dec 14. PMID: 15598694
  2. Silverman SL, Landesberg R. Osteonecrosis of the jaw and the role of bisphosphonates: a critical review. Am J Med. 2009 Feb;122(2 Suppl):S33-45. PMID: 19187811
  3. Ruggiero SL, Fantasia J, Carlson E. Bisphosphonate-related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Oct;102(4):433-41. PMID: 16997108
  4. Ruggiero S, Gralow J, Marx RE et al Practical guidelines for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in patients with cancer. J Oncol Pract. 2006 Jan;2(1):7-14. PMID: 20871729
  5. Shannon J, Shannon J, Modelevsky S, Grippo AA. Bisphosphonates and osteonecrosis of the jaw. J Am Geriatr Soc. 2011 Dec;59(12):2350-5. Review. PMID: 22091898
  6. Kuhl S, Walter C, Acham S, Pfeffer R, Lambrecht JT. Bisphosphonate-related osteonecrosis of the jaws--a review. Oral Oncol. 2012 Oct;48(10):938-47. Epub 2012 Apr 21. Review. PMID: 22525606
  7. Whitefield S et al. Medication-related osteonecrosis of the jaw: A cross-sectional study on the prevalence of cutaneous manifestations and the primary care physician's role in its early diagnosis. Am J Med 2024 Mar; 137:266. PMID: 38042241 https://www.amjmed.com/article/S0002-9343(23)00741-6/abstract