J Korean Assoc Oral Maxillofac Surg.  2010 Aug;36(4):291-302. 10.5125/jkaoms.2010.36.4.291.

Study on bisphosphonate-related osteonecrosis of the jaw (BRONJ): case report and literature review

• Kim YG
• Lee BS
• Kwon YD
• Suh JH
• Jeen SM

• KMID: 1457782
• DOI: http://doi.org/10.5125/jkaoms.2010.36.4.291

Abstract

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a side effect of Bisphosphonates (BPs) use. These days, oral bisphosphonates are normally prescribed to treat osteoporosis. Intravenous BPs are used extensively to treat osteolytic bone lesions related to multiplemyeloma and bone metastasis of solid cancers, breast cancer or prostate cancer. As the prescription of BPs is universalized and the number of people treated with BPs is increasing, an accurate understanding and proper management of BRONJ are required. The aim of this study was to improve the clinicians'understanding of BRONJ by reviewing the literature. To achieve this, this paper introduces case reports as well as the current concept of BRONJ based on the 2009 updates by American Association of Oral and Maxillofacial (AAOMS) including the definition, epidemiology, etiology, diagnosis, treatment and prevention of BRONJ.

Keyword

Bisphosphonate; Osteonecrosis; Osteoporosis; Jaw diseases

MeSH Terms

Bisphosphonate-Associated Osteonecrosis of the Jaw
Breast Neoplasms
Diphosphonates
Jaw Diseases
Neoplasm Metastasis
Osteonecrosis
Osteoporosis
Prescriptions
Prostatic Neoplasms
Diphosphonates

Figure

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  Fig. 1. A. Delayed healing of the extraction wounds with exposure of alveolar bone and pus discharge of the maxillary right first premolar. B. Maxillary left second premolar and second molar.

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  Fig. 2. Radiolucent status with ill-defined border of the lesion area is observed in the panoramic view of the initial examination.

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  Fig. 3. Bilateral maxillary sinus area haziness is shown in the water's view of the initial examination.

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  Fig. 4. Bone destruction status is observed in the maxillary left and right lesion area, sequestrum formation can be identified in the maxillary right lesion area, and reactive osteophytic status is shown in the sinus floor area in the lesion area of the maxillary left side in the dental computed tomography (CT) image of the initial examination.

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  Fig. 5. After 3 months from the initial visit, the inflammatory state has been clinically relieved and according to the panoramic view taken for preoperative examination purpose, significant bone formation and sequestrum (maxillary left molar and premolar area) formation can be identified.

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  Fig. 6. A. Left Maxillary Lesion, B. The Sequestrum was removed, and the tissue removed was further examined through biopsy for a confirmed diagnosis.

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  Fig. 7. Four weeks after surgery, according to the radiographic image the irregularity of the maxillary left and right surgery area has decreased and, due to new bone formation, was merging with the adjacent bone.

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  Fig. 8. Six weeks after surgery, the surgery area of the maxillary left and right side is healing progressively.

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  Fig. 9. Ten weeks after surgery, according to radiographic image, the bone of the surgery area in the maxillary left and right side is maturing into similar configuration as the adjacent bone.

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  Fig. 10. Nitrogen-containing bisphosphonates inhibit farnesyl diphosphate (FPP) synthase, an enzyme in mevalonate pathway. FPP synthase is responsible for isoprenylation of small GTPases that promote an array of activities in the osteoclasts that control bone resorption. Without this activity, bone resorption is slowed. (HMG: 3-hydroxy-3-methylglutaryl)

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  Fig. 11. Bisphosphonates used most frequently in the clinic today have a characteristic structure. All have a hydroxyl group on the carbon atom that confers high affinity for calcium and the skeleton. They vary only at the R-group, which always contains a nitrogen atom that is in either an alkyl or a heterocyclic structure.

Reference

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