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Arch Hellen Med, 26(5), September-October 2009, 583-592


Bisphosphonate-induced osteonecrosis of the jaws: Prevention and management

Department of Oral Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece

Bisphosphonates are a group of drugs that have a significant effect on bone structure, preventing normal bone remodeling. They can be administered orally or intravenously, and are of great importance for the treatment of osteoporosis, Paget's disease, osteogenesis imperfecta, osteopenia, bone metastases from various malignancies, most commonly breast and prostate cancer, and multiple myeloma. Bisphosphonate-associated osteonecrosis presents with the finding of avascular bone in the maxilla or the mandible and, according to clinical stage, pain, inflammation, fractures and/or extensive osteolysis. In the vast majority of cases, the patients had been on intravenous drug therapy and had undergone dentoalveolar surgery. For the patients receiving oral bisphosphonates the risk increases if the treatment exceeds a 3-year period. All the patients taking biphosphonates should be on a strict recall programme. Prevention is of great significance and includes meticulous oral hygiene and the avoidance of dentoalveolar surgery. The management of osteonecrosis is primarily conservative and, depending on the stage of the disease, may involve use of antiseptic solutions, antibiotic coverage and/or surgical procedures. The discontinuation of the intravenous treatment is not recommended, while patients on oral bisphosphonates are advised to stop the treatment for a period of time for prevention and/or management of osteonecrosis, with the approval of the attending physician.

Key words: Bisphosphonates, Osteonecrosis.

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