Bisphosphonates are used worldwide as a successful treatment for people with
osteoporosis, which is the major underlying cause of fractures in postmenopausal women and older adults. These agents are successful at increasing bone mass and bone trabecular thickness, decreasing the risk of fracture, and decreasing bone
pain, enabling individuals to have better quality of life.
Bisphosphonates are also used to treat
multiple myeloma, bone
metastasis, and Paget's disease; however,
bisphosphonate treatment may result in negative side effects, including
osteonecrosis of the jaw (ONJ). ONJ involves necrotic, exposed bone in the jaw,
pain, possible
secondary infection, swelling, painful lesions, and various
dysesthesias, although less-severe cases may be asymptomatic. First-generation
bisphosphonates, which do not contain
nitrogen, are metabolized into a nonfunctional, cytotoxic analogue of
adenosine triphosphate and cause osteoclast death by
starvation. Second-generation
bisphosphonates are
nitrogen-containing agents; these inhibit osteoclast vesicular trafficking, membrane ruffling, morphology, and cytoskeletal arrangement by inhibiting
farnesyl diphosphate synthase in the
mevalonate pathway. Physicians treating older adults with
osteoporosis and
cancer should work together with dental practitioners, pharmacists, and other clinicians to inform individuals receiving
bisphosphonates of their possible side effects and to suggest precautionary steps that may minimize the risk of
osteonecrosis, particularly of the jaw. These include practicing good
oral hygiene; scheduling regular dental examinations and cleanings; and cautioning people who are scheduling treatment for
periodontal disease, oral and maxillofacial
therapy,
endodontics, implant placement, restorative dentistry, and
prosthodontics. Recommendations for management of people with ONJ include an oral rinse, such as
chlorhexidine, and
antibiotics.