A Review of Bisphosphonates and Bisphosphonate-related Osteonecrosis of the Jaw

Statement of Problems: Bisphosphonates are a class of agents used in treating a variety of bone diseases, including osteoporosis, multiple myeloma and hypocalcemia due to malignancy. Despite the benefits related to the use of these medications, in recent years, numerous cases of bisphosphonate-related osteonecrosis of the jaws (BRONJ) of patients treated with oral/IV bisphosphonates have been reported. The BRONJ phenomenon is a serious complication, presenting as an exposure of alveolar bone either spontaneously or secondary to invasive oral surgical procedures. This review aimed to warn dentists and dental specialists about BRONJ and propose guidelines for diagnosis, staging, management and treatment selection based on the available data and the authors’ experiences. All the patients treated with oral or IV bisphosphonate therapyare are at risk of BRONJ. Suggested guidelines for these two applied forms of bisphosphonates vary. In IV bisphosphonate therapy, all dentoalveolar surgeries are contraindicated and should be avoided. However, the indications are more controversial in the cases of bisphosphonates administered via the oral route and are related to the duration of treatment.