Current perspectives in the management of patients with drug-induced osteonecrosis of the maxilla: experience of the school of Naples Federico II

Background

Abstract Objective. The use of bisphosphonates (zoledronic acid) in the treatment of metastatic bone disease and osteoporosis has been raised during recent years. The purpose of this treatment is mainly to reduce skeletal-related events, e.g. pain and pathological fractures. Bisphosphonate-related osteonecrosis of the jaw. (BRONJ) adversely affects the quality of life, producing significant morbidity in afflicted patients. BRONJ can develop spontaneously or after minor trauma. In general, these patients seem to have less severe manifestations of necrosis and respond more readily to stage-specific treatment regimens (Table 1). Strategies for the treatment of patients with, or at risk of, BRONJ we reset forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws (Position Paper) and approved by the Board of Trusteesin September 2006.¹This update contains revisions to the diagnosis and staging and management strategie sand highlights the status of basic science research. We to report the incidence of bisphosphonate-related osteonecrosis of the jaw (ONJ), since the initiation of a routine maxillofacial examination before treatment with bisphosphonates, no ONJ has been seen.

Table 1 Staging and treatment strategies

Conclusions

ONJ is a rare but a very serious complication in relation to treatment with bisphosphonates. To decrease the incidence of ONJ, a maxillofacial examination could be performed in all patients before treatment with bisphosphonates.