Acta Scientific Dental Sciences (ISSN: 2581-4893)

Research ArticleVolume 5 Issue 6

Bisphosphonates Related Osteonecrosis of the Jaw: Systematic Review of the Literature

SM Bouzoubaa, Mahad Chaimae*, S Ait Lhaj and I Benyahya

Oral Surgery Department, Dental Consultation and Treatment Center, Ibn Rochd University Hospital Center, Casablanca, Morocco

*Corresponding Author: Mahad Chaimae, Oral Surgery Department, Dental Consultation and Treatment Center, Ibn Rochd University Hospital Center, Casablanca, Morocco.

Received: April 12, 2021; Published: : May 21, 2021

Citation: Mahad Chaimae., et al. “Bisphosphonates Related Osteonecrosis of the Jaw: Systematic Review of the Literature". Acta Scientific Dental Sciences 5.6 (2021): 104-111.


Objectives: The aim of this review is to assess the route of administration of bisphosphonates (BPs) most likely to generate osteonecrosis of the jaw (ONJ) while determining the profile of patients receiving this type of treatment.

Methods: A literature search in PubMed, EMBASE and Cochrane of randomized controlled clinical trials, systematic reviews and meta-analyzes was carried out between 2007 and 2018 using the terms bisphosphonates (BPs), oral, intravenous and osteonecrosis of the jaws.

The number of publications by year, type of publication and level of proof of the articles were assessed. Likewise, the incidences of occurrence of ONJ according to each route of administration of BPs and the profile of patients receiving this treatment were identified.

Results: 3456 publications published since 2007, mainly in oncology and maxillofacial journals, were reviewed. 6 publications whose level of proof corresponds to our objective were selected.

Discussion: Studies have shown a wide variety in design and a strong incidence of ONJ depending on the route of administration of Bps. A higher prevalence has been observed following intravenous administration.

Keywords: Osteonecrosis of the Jaw; Bisphosphonates; Oral Route; Venous Route


  1. Ait Lhaj S. “Ostéonécrose des maxillaires dues aux bisphosphonates: revue systématique de littérature”. Thèse Med dent Casablanca (2018).
  2. Koth VS., et al. “Bisphosphonate-related osteonecrosis of the jaw: from the sine qua non condition of bone exposure to a non-exposed BRONJ entity”. Dentomaxillofacial Radiology 7 (2016): 20160049.
  3. Marx RE. “Reconstruction of defects caused by bisphosphonate-induced osteonecrosis of the jaws”. Journal of Oral and Maxillofacial Surgery 5 (2009): 107-119.
  4. Ruggiero SL., et al. “Bisphosphonate-related osteonecrosis of the jaw: background and guidlines for diagnosis, staging and management”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 4 (2006): 433-441.
  5. Mücke T., et al. “Prevention of Bisphosphonate-Related Osteonecrosis of the Jaws in Patients with Prostate Cancer Treated with Zoledronic acid – a prospective study over 6 years”. Journal of Cranio-Maxillo-Facial Surgery10 (2016): 1689-1693.
  6. Solomon DH., et al. “Defining the epidemiology of bisphosphonate-associated osteonecrosis of the jaw: prior work and current challenges”. Osteoporosis International 24 (2013): 237-244.
  7. Rugani P., et al. “Prevalence of bisphosphonate-associated osteonecrosis of the jaw after intravenous zoledronate infusions in patients with early breast cancer”. Clinical Oral Investigations 2 (2014): 401-407.
  8. Goodwin JS., et al. “Risk of Jaw Osteonecrosis After Intravenous Bisphosphonates in Cancer Patients and Patients Without Cancer”. Mayo Clinic Proceedings 1 (2017): 106-113.
  9. T Shintani., et al. “Comparison of the prognosis of bisphosphonate-related osteonecrosis of the jaw caused by oral and intravenous bisphosphonate”. International Journal of Oral and Maxillofacial Surgery 7 (2015): 840-844.
  10. Gimsing P., et al. “Effect of pamidronate 30 mg versus 90 mg on physical function in patients with newly diagnosed multiple myeloma (Nordic Myeloma Study Group): a double-blind, randomised controlled trial”. Lancet Oncology 11 (2010): 973-982.
  11. Fonseca FP., et al. “Alendronate-associated osteonecrosis of the jaws: A review of the main topics”. Medicina Oral, Patologia Oral, Cirugia Bucal 2 (2014): e106-111.
  12. Advisory Task Force on Bisphosphonate- Related Osteonecrosis of the Jaws. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws”. Journal of Oral and Maxillofacial Surgery 3 (2007): 369-376.
  13. Abi Najm S., et al. “Osteonécrose des maxillaires chez les patients traités par bisphosphonates”. La Presse Médicale 34 (2005): 1073-1077.
  14. Ecker AW., et al. “Bisphosphonate-related jaw necrosis – Severe complication in maxillofacial Surgery”. Cancer Treatment Reviews 1 (2007): 58-63.
  15. Maes JM., et al. “Ostéonécrose des maxillaires sous bisphosphonates”. The Medico-Chirurgical Journal and Review Stomatologie (2007): 1-17.
  16. Srinivasan D., et al. “Orofacial pain – a presenting symptom of bisphosphonate associated osteonecrosis of the jaws”. British Dental Journal 2 (2007): 91-92.
  17. Edwards BJ., et al. “Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy: an advisory statement from the American Dental Association Council on Scientific Affairs”. Journal of the American Dental Association 12 (2008): 1674-1677.
  18. Blandine R., et al. “Attention aux effets indésirables des bisphosphonates: ulcérartion muqueuse, retard cicatriciel et ostéonécrose. Mise au point et conduite à tenir”. Odonto-Stomatol., 233 (2006): 7-15.
  19. Hutcheson A., et al. “A C-terminal cross-linking telopeptide test-based protocol for patients on oral bisphosphonates requiring extraction: a prospective single-center controlled study”. Journal of Oral and Maxillofacial Surgery 72 (2014): 1456-1462.
  20. Kunchur R., et al. “Clinical investigation of C-terminal cross-linking telopeptide test in prevention and management of bisphosphonate-associated osteonecrosis of the jaws”. Journal of Oral and Maxillofacial Surgery 67 (2009): 1167-1173.
  21. Marx R., et al. “Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment”. Journal of Oral and Maxillofacial Surgery 65 (2007): 2397-2410.
  22. Filali S., et al. “Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blindedactive-controlled phase III trials in cancer patients with bone metastases”. Annals of Oncology 5 (2012): 1341-1347.
  23. Michael M., et al. “Ostéonécrose maxillaire associée aux bisphosphonates: Présentation d’un cas et revue de la littérature”. Mens. Suisse Odontostomatol., 116.10 (2006): 1043-1047.
  24. Migliorati C., et al. “Managing the care of patients with bisphosphonate associated osteonecrosis”. Journal of the American Dental Association 136 (2005): 1658-1668.
  25. Purcell P and Body I. “Bisphosphonates and osteonecrosis of the jaw”. Medical Journal of Australia 182 (2005): 417-418.
  26. Hoff A., et al. “Osteonecrosis of the jaw in patients receiving intravenous bisphosphonate therapy”. Journal of Clinical Oncology 24 (2006): 8528.
  27. Lescaille G and Baaroun V. “Conduite à tenir face à un patient traité par des inhibiteurs de la résorption osseuse à risque d'ostéonécrose des mâchoires”. Medicina Oral Patologia Oral y Cirugia Bucal 2 (2019).

Copyright: © 2021 Mahad Chaimae., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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