Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases

Purpose Bisphosphonates (BPs) are bone-remodeling inhibitors that are used to manage bone metastases and osteoporosis. Osteonecrosis of the jaw, however, can occur during treatment. This complication is poorly understood and is called "bisphosphonate-induced osteonecrosis of the jaw'' (BIOJ). Methods We performed a PubMed-based review of all of the described cases of BIOJ from January 2003 (the year of the first description) to September 2009. Issues of clinical relevance, such as the primary diagnosis and type of treatment, were evaluated for each patient case. Results We retrieved 2,408 cases, 88% of which were associated with intravenous therapy, primarily with zoledronate. Of the total number of cases, 89% were associated with the treatment of a malignant condition, particularly multiple myeloma (43% of the cases). Of all the BIOJ cases, 67% were preceded by tooth extraction and only 35% of patients were cured. Conclusion Prevention is better than treatment, and the establishment of meticulous oral hygiene and surgical procedures prior to commencing BP treatment is important for preventing BIOJ. Our review summarizes the current knowledge about this severe complication. Future studies,