Bisphosphonate-Associated Osteonecrosis of the Jaw

Necrotic jaws or other maxillofacial skeleton necrosis associated with bisphosphonate use (see BISPHOSPHONATES). Injury, dental procedures, and trauma can trigger the necrotic process.

Also Known As:

Bisphosphonate-Associated Osteonecrosis of the Jaws; Bisphosphonate-Induced Osteonecrosis of the Jaw; Bisphosphonate-Induced Osteonecrosis of the Jaws; Bisphosphonate-Related Osteonecrosis of the Jaw; Osteonecrosis of the Jaw, Bisphosphonate-Associated; Osteonecrosis of the Jaw, Bisphosphonate-Induced; Osteonecrosis of the Jaw, Bisphosphonate-Related; Osteonecrosis of the Jaws, Bisphosphonate-Associated; Osteonecrosis of the Jaws, Bisphosphonate-Induced; Osteonecrosis of the Jaws, Bisphosphonate-Related; Bisphosphonate Associated Osteonecrosis; Bisphosphonate Associated Osteonecrosis of the Jaw; Bisphosphonate Associated Osteonecrosis of the Jaws; Bisphosphonate Induced Osteonecrosis of the Jaw; Bisphosphonate Induced Osteonecrosis of the Jaws; Bisphosphonate Osteonecroses; Bisphosphonate Related Osteonecrosis of the Jaw; Bisphosphonate-Associated Osteonecroses; Osteonecroses, Bisphosphonate; Osteonecroses, Bisphosphonate-Associated; Osteonecrosis of the Jaw, Bisphosphonate Associated; Osteonecrosis of the Jaw, Bisphosphonate Induced; Osteonecrosis of the Jaw, Bisphosphonate Related; Osteonecrosis of the Jaws, Bisphosphonate Associated; Osteonecrosis of the Jaws, Bisphosphonate Induced; Osteonecrosis of the Jaws, Bisphosphonate Related; Osteonecrosis, Bisphosphonate; Osteonecrosis, Bisphosphonate-Associated; Bisphosphonate Osteonecrosis; Bisphosphonate-Associated Osteonecrosis

Networked: 450 relevant articles (8 outcomes, 49 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Multiple Myeloma
2.	Osteoporosis
3.	Osteonecrosis (Kienbock's Disease)
4.	Osteoradionecrosis
5.	Osteomyelitis

Experts

1.	Walter, Christian: 11 articles (09/2018 - 10/2006)
2.	Pautke, Christoph: 10 articles (07/2015 - 03/2009)
3.	Otto, Sven: 9 articles (07/2015 - 01/2010)
4.	Ziebart, Thomas: 8 articles (06/2022 - 02/2011)
5.	Allegra, Alessandro: 6 articles (01/2020 - 09/2007)
6.	Musolino, Caterina: 6 articles (01/2020 - 09/2007)
7.	Al-Nawas, Bilal: 6 articles (09/2018 - 11/2008)
8.	Walter, C: 6 articles (04/2017 - 02/2010)
9.	Ziebart, T: 6 articles (04/2017 - 02/2010)
10.	Wehrhan, Falk: 5 articles (02/2020 - 04/2010)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Bisphosphonate-Associated Osteonecrosis of the Jaw:

1.	Teriparatide (Parathar)FDA Link 08/01/2012 - "We report on the case of a severely osteoporotic elderly Japanese woman with bisphosphonate-associated osteonecrosis of the jaw (ONJ), who was treated successfully with teriparatide. " 01/01/2014 - "The objectives of this study were to establish a bisphosphonate-related osteonecrosis of the jaw (BRONJ) rat model and to analyse the effects of teriparatide (TP) on this model. " 01/01/2022 - "Management of bisphosphonate-related osteonecrosis of the jaw using teriparatide treatment: A systematic review." 04/01/2020 - "The effects of different doses of teriparatide on bisphosphonate-related osteonecrosis of the jaw in mice." 12/01/2015 - "Administration of teriparatide improves the symptoms of advanced bisphosphonate-related osteonecrosis of the jaw: preliminary findings."
2.	Anti-Bacterial Agents (Antibiotics)IBA 07/01/2011 - "The patient, who received prophylactic antibiotics intraoperatively, demonstrated no clinical signs of bisphosphonate-associated osteonecrosis when seen at follow-up. " 02/01/2011 - "Relevance of a prolonged preoperative antibiotic regime in the treatment of bisphosphonate-related osteonecrosis of the jaw." 02/01/2009 - "The current strategies for the prevention of bisphosphonate osteonecrosis include chlorhexidene mouthwash and pre- and post-operative antibiotics. " 08/01/2016 - "It can be concluded that combined treatment with antibiotics, minimally invasive surgery (including Er:YAG laser surgery), and low-level laser therapy in the early stages of the disease should be the gold standard for bisphosphonate-related osteonecrosis of the jaw management. " 01/01/2012 - "Oral infection is considered to play a critical role in the pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ), and antibiotic therapy has become a mainstay of BRONJ therapy. "
3.	Diphosphonates (Bisphosphonates)IBA 12/01/2015 - "The aim of this study was to evaluate the knowledge of Brazilian dentists (DEN) and dental students (DS) about bisphosphonates (BP) and bisphosphonate-related osteonecrosis of the jaw (BRONJ). " 11/01/2013 - "Studies included imaging of the skull with a special focus on bisphosphonate-induced osteonecrosis of the jaw in patients treated with bisphosphonates due to benign or malignant bone changes. " 05/16/2012 - "Any randomized controlled trial (RCT) assessing the role of bisphosphonates and observational studies or case reports examining bisphosphonate-related osteonecrosis of the jaw in patients with MM were eligible for inclusion. " 12/01/2011 - "The aim of this study was to (1) evaluate the fractal dimension (FD) in regions of the mandible on cone beam CT (CBCT) images of patients with bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) and (2) to select the most suitable region of interest (ROI) for further study on detection of bone alterations associated with bisphosphonates. " 07/21/2023 - "Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare but severe adverse effect that can occur as a result of bisphosphonate treatment. "
4.	Zoledronic Acid (Zometa)FDA Link 09/01/2015 - "There is still controversy about the best treatment strategy for patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) stage I. Therefore, the aim of the present study was to analyse the effect of a nonsurgical treatment protocol in patients with BRONJ stage I. During the study period we included 17 patients (11 male; 6 female) who presented with a total of 24 separate areas of BRONJ, stage I. All patients were exclusively treated with a monthly intravenous regime of zoledronic acid due to an underlying malignant disease. " 01/01/2018 - "The aim was to assess the effect of a relevant regimen of zoledronic acid (ZA) treatment for the study of bisphosphonate-related osteonecrosis of the jaw on alveolar bone microstructure and vasculature. " 01/01/2021 - "Zoledronic acid (Zol) is a widely used intravenous aminobisphosphonate to treat both benign and malignant skeletal diseases, and bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious side effect whose pathophysiology remains poorly understood. " 07/01/2019 - "Thirty Albinus Wistar male rats were administered 0.035 mg/kg zoledronic acid intravenously for 8 weeks, divided into four administrations with a 2-week interval between each application, after which their upper right central incisors were extracted to induce the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). " 01/01/2019 - "Zoledronic acid, the most frequent agent associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ), has been reported as cytotoxic for bone and vascular cells. "
5.	Dental Implants (Dental Implant)IBA 06/01/2014 - "The aims of this study were to quantify bone mineral density (BMD) and trabecular architecture of sequestra in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) associated with dental implants and to assess if there are differences between trabecular bone in "implant loading-triggered" and "implant surgery-triggered" BRONJ. " 10/01/2023 - "The purpose of this review is to examine the literature on the topic of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and dental implant failure in patients undergoing bisphosphonate (BP) therapy who also received dental implants before, during, or after BP treatment, as compared to healthy patients. " 01/01/2021 - "Dental implant treatment in patients prescribed medications is associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ) around the implants. " 12/01/2016 - "Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is caused by dental extraction, dental implant surgery, and denture wearing; however, it occurs spontaneously. " 09/01/2016 - "It remains unclear whether dental implants are a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). "
6.	Oxygen (Dioxygen)IBA 07/01/2007 - "Hyperbaric oxygen treatment and bisphosphonate-induced osteonecrosis of the jaw: a case series." 11/01/2015 - "As treatment protocols based on randomized controlled trials (RCTs) do not exist, we critically reviewed the existing data concerning the management of bisphosphonate-related osteonecrosis of the jaw, including the most recent data for the use of teriparatide and hyperbaric oxygen. " 07/01/2012 - "What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics." 07/01/2012 - "This study tested hyperbaric oxygen (HBO) as an adjunct to surgery and antibiotics in the treatment of bisphosphonate-related osteonecrosis of the jaw (ONJ) and evaluated its effects on gingival healing, pain, and quality of life. " 11/01/2006 - "Hyperbaric oxygen in addition to antibiotic therapy is effective for bisphosphonate-induced osteonecrosis of the jaw in a patient with multiple myeloma."
7.	Biomarkers (Surrogate Marker)IBA 05/11/2023 - "Identification of Potential Biomarkers and Small Molecule Drugs for Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ): An Integrated Bioinformatics Study Using Big Data." 04/01/2018 - "For this study, the aim was to identify combined biomarkers associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ). " 04/01/2016 - "The aim of this study was to investigate a possible biomarker for bisphosphonate-related osteonecrosis of the jaw (BRONJ) in an animal model. " 02/01/2022 - "Serum biomarkers for bisphosphonate-related osteonecrosis of the jaw: a prospective clinical study." 04/01/2018 - "Identifying a combined biomarker for bisphosphonate-related osteonecrosis of the jaw."
8.	Alendronate (Alendronate Sodium)FDA LinkGeneric 01/01/2019 - "We developed a rat model of bisphosphonate-related osteonecrosis of the jaw (BRONJ) by removing a maxillary molar tooth (M1) from ovariectomized rats after treatment with alendronate. " 01/01/2014 - "Her condition was diagnosed as stage 2 bisphosphonate-related osteonecrosis of the jaw caused by trauma, and she was advised to discontinue alendronate. " 12/01/2010 - "The published evidence does not suggest a need for stopping osteoporosis medications after the first 4-5 years out of concern about bisphosphonate-induced osteonecrosis of the jaw or alendronate-induced atypical fractures. " 07/01/2010 - "This report documents a case of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after dental implant placement in an osteoporotic patient treated with alendronate for 6 years. " 01/01/2019 - "The aim of this study was to elucidate the role of fibroblasts in bisphosphonate-related osteonecrosis of the jaw (BRONJ), evaluating the effect of zoledronate, alendronate, and ibandronate on the proliferation of fibroblasts and on their expression of genes essential for fibroblast physiology. "
9.	geranylgeraniolIBA 01/01/2022 - "The Role of Geranylgeraniol in Managing Bisphosphonate-Related Osteonecrosis of the Jaw." 09/01/2015 - "Geranylgeraniol (GGOH) has been reported as a potential treatment option for bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ). " 05/01/2011 - "Comments on ''Geranylgeraniol--a new potential therapeutic approach to bisphosphonate associated osteonecrosis of the jaw" by Ziebart T et al. (2011)." 03/01/2011 - "Geranylgeraniol - a new potential therapeutic approach to bisphosphonate associated osteonecrosis of the jaw." 04/01/2017 - "Recent studies focused on angiogenesis in the pathophysiology of bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) and identified geranylgeraniol (GGOH) as a feasible option for BP-ONJ therapy. "
10.	Ibandronic Acid (Boniva)FDA Link 01/01/2019 - "The aim of this study was to elucidate the role of fibroblasts in bisphosphonate-related osteonecrosis of the jaw (BRONJ), evaluating the effect of zoledronate, alendronate, and ibandronate on the proliferation of fibroblasts and on their expression of genes essential for fibroblast physiology. " 01/01/2013 - "Key words searched included: adverse effects (AEs), aged, alendronate, atrial fibrillation, atypical fractures, bisphosphonate-associated osteonecrosis of the jaw, bisphosphonates, diaphyseal fractures, gastrointestinal cancer, ibandronate, musculoskeletal pain, osteoporosis, risedronate, subtrochanteric fractures, and zoledronic acid. " 04/01/2015 - "The study objective was to evaluate the effect on osteoblast growth of high concentrations of three nitrogen-containing bisphosphonates (pamidronate, alendronate, and ibandronate) and one non-nitrogen-containing bisphosphonate (clodronate), using the MG-63 cell line as an osteoblast model, in order to determine the role of osteoblasts in bisphosphonate-related osteonecrosis of the jaw (BRONJ). "

Therapies and Procedures

1.	Low-Level Light Therapy (LLLT) 01/01/2016 - "Bisphosphonate-related osteonecrosis of the jaw: a review of the potential efficacy of low-level laser therapy." 10/01/2014 - "Clinical studies have shown that low-level laser therapy (LLLT) can improve local tissue healing of bisphosphonate-induced osteonecrosis of the jaw. " 04/01/2010 - "The aim of this study was to detail the clinical efficacy of low-level laser therapy (LLLT) for the management of bisphosphonate-induced osteonecrosis of the jaws (ONJ-BP). " 08/01/2016 - "The present systematic review of the literature sought to elucidate whether low-level laser therapy has positive effects on the treatment of bisphosphonate-related osteonecrosis of the jaw. " 05/01/2012 - "Laser GaAlAs (λ860 nm) photobiomodulation for the treatment of bisphosphonate-induced osteonecrosis of the jaw."
2.	Therapeutics 01/01/2019 - "This study demonstrates that treatment with PRF/PRP may have positive effects in the therapy of Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ)." 01/01/2021 - "In recent years, however, bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been a rare but major complication of this therapy. " 12/08/2020 - "Although uncommon in patients under oral therapy, bisphosphonate-related osteonecrosis of the jaw (BRONJ) can be a very severe issue. " 04/01/2016 - "The purpose of this retrospective study was to compare the clinical significance of panoramic radiography (orthopantomography [OPTG]) and cone beam computed tomography (CBCT) for therapy planning of bisphosphonate-related osteonecrosis of the jaw (BRONJ) by surgeons. " 01/01/2016 - "Multipotent mesenchymal stromal cell sheet therapy for bisphosphonate-related osteonecrosis of the jaw in a rat model."
3.	Tooth Extraction (Tooth Extractions) 01/01/2010 - "To test the efficacy of a protocol in preventing the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction. " 05/01/2015 - "As the most suitable approach for preventing bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients undergoing surgical tooth extraction is still under discussion, the present study evaluates the incidence of BRONJ after surgical tooth extraction using a standardized surgical protocol in combination with an adjuvant perioperative treatment setting in patients who are at high-risk for developing BRONJ. " 01/01/2023 - "Platelet-rich plasma is utilized in sinus lift procedures, after tooth extractions, and in patients undergoing the treatment of bisphosphonate-related osteonecrosis of the jaw. " 06/30/2021 - "Tooth extraction with long-term ZA and DX administration inhibited bone remodeling and induced bisphosphonate-related osteonecrosis of the jaw-like lesions. " 01/01/2020 - "Tooth extractions are suspected to be a major trigger for the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). "
4.	Free Tissue Flaps 01/01/2016 - "Current treatment guidelines caution against osseous reconstruction using free flap tissue to treat bisphosphonate-related osteonecrosis of the jaw (BRONJ). " 07/01/2014 - "Outcomes of osseous free flap reconstruction in stage III bisphosphonate-related osteonecrosis of the jaw: systematic review and a new case series." 05/01/2014 - "Microsurgical reconstruction after bisphosphonate-related osteonecrosis of the jaw: our experience with fibula free flap." 05/01/2008 - "Fibula free flap with endosseous implants for reconstructing a resected mandible in bisphosphonate osteonecrosis." 09/01/2022 - "PubMed was searched for MeSH terms "Quality of life," "Osteonecrosis," "Osteoradionecrosis," "Bisphosphonate-associated osteonecrosis of the jaw," "Free tissue flaps," and "Mandibular reconstruction." English language studies with QOL outcomes data for patients undergoing free flap reconstruction for advanced ONJ were included. "
5.	Mandibular Reconstruction 09/01/2022 - "PubMed was searched for MeSH terms "Quality of life," "Osteonecrosis," "Osteoradionecrosis," "Bisphosphonate-associated osteonecrosis of the jaw," "Free tissue flaps," and "Mandibular reconstruction." English language studies with QOL outcomes data for patients undergoing free flap reconstruction for advanced ONJ were included. " 11/01/2015 - "Successful long-term mandibular reconstruction and rehabilitation using non-vascularised autologous bone graft and recombinant human BMP-7 with subsequent endosseous implant in a patient with bisphosphonate-related osteonecrosis of the jaw." 08/12/2020 - "Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare but potentially devastating complication of extended use of bisphosphonates. fibula free flaps (FFFs) are the gold standard of mandibular reconstruction. "