BoneKEy-Osteovision | Perspective
Jaw bone necrosis and bisphosphonates: Microanatomical questions
Alan Boyde
DOI:10.1138/20060229
Abstract
Reports of an association between bisphosphonate administration and osteonecrosis of the jaw (ONJ) recently appeared from several centers worldwide. In particular, it was noted that the most powerful bisphosphonate on the market, zoledronic acid, was implicated. This drug was recommended for — and successful in — the treatment of hypercalcemia of malignancy and generally for the alleviation of the symptoms of tumors metastasizing to bone. The dominant association of ONJ with zoledronic acid reflects the potency of this drug in the alleviation of problems caused by bone metastases, particularly multiple myeloma, in patients with long lasting, poor dental maintenance. The older, partially edentulous human mandible may contain sizeable tracts of dead bone and its bone tissue is also more highly mineralized than in other bones, but this does not seem to be a problem. Bisphosphonates cause excess bone mineralization and may perhaps interfere with capillary blood vessel maintenance – this would be critical at the junction of cortical bone with the mucoperiosteum. Osteocytic death results in excess mineralization. We need to know whether zoledronic acid or other bisphosphonates damage osteoblasts and osteocytes.
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