Join us   Log in  


Pages: 490-498
Print Article   Download XML  Download PDF

Osteonecrosis of the Jaw Induced by Biphosphonates: About 2 Clinical Cases

Author: Oussama Nabih, Ihsane Benyahya

Category: JMSR Dentistry


Biphospohonates are a class of drugs used to treat multiple disorders of calcium metabolism. Since 2003, patients receiving therapies concomitants with biphosphonates have suffered new complications associated with osteonecrosis of the jaw. Bone necrosis of the maxilla is rare but potentially dramatic. It manifests by a wound of the gum, lesion exposing necrotic bone and episode of clinical infections. These complications may be caused by trauma or dental surgery, but it can be also spontaneous.

We report two cases of osteonecrosis of the jaw. The first case is a mandibular osteonecrosis occurring after tooth extraction in a patient receiving intravenous bisphosphonate. Medical and surgical management has been undertaken with a regular clinical follow up. The second case is a sequestered maxillary osteonecrosis induced by bisphosphonate, that fall down after medical treatment, leading to an oro-antral communication.

The management of this complication remains problematic and the surgical treatment is difficult as for the result is uncertain. Emphasis should therefore be placed on preventive and conservative measures for all patients treated with bisphosphonates, as their therapeutic efficacy seems indisputable. The best attitude remains preventive management of these patients prior to initiation of biphosphonate therapy.

Keywords: Biphosphonates, Jaw, Osteonecrosis


1- M Gunepin, F Derache, J-P De Jaureguibery, J-S Bladé, O Gisserot, O Cathelinaudand al.Ostéonécroses des maxillaires dues aux bisphosphonates administrés par voie intraveineuse : incidence et facteurs de risque Med Buccale Chir Buccale 2013;19:21-31

2- S Abi Najm, Ph Lesclous, T Lombardi,I Bouzouta, J-P Carrel, J Samson.Ostéonécrose des maxillaires dues aux bisphosphonates : mise au point. Médecine buccale chirurgie buccale VOL. 14, N° 1 2008

3- Agarwala S, Sule A, Pai BU, Joshi VR.Alendronate in the treatment of avascular necrosis of the hip. Rheumatology 2002; 41 : 346-7.

4- Amital H, Applbaum H, Aamar S, Daniel N, Rubinow A.SAPHO syndrome treated with pamidronate: an openlabel study of 10 patients. Rheumatology 2004 ; 43 :658-61.

5-Veyrac G, Lebreton A, Jolliet P. Ostéonécroses de la mandibule et/ou du maxillaire associées à la prise de bisphosphonates. Lettre du Pharmacologue 2009;23:41-7.

6- Guillaume B, Chappard D. Ostéonécrose de la mâchoire et chirurgie implantaire. Rapport et prévention thérapeutique. Chir Dent Fr 2008;78:45-52.

7- Abi Najm S, Lysitsa S, Carrel JP, Lesclous P, Lombardi T, SamsonJ. Ostéonécrose des maxillaires chez des patients traités par bisphosphonates. Presse Med 2005;34:1073-7.

8-Lesclous P, Abi Najm S, Samson J. Bisphosphonates et pratique bucco-dentaire. Rev OdontStomat 2011;40:173- 91.

9. Walter C, Al-Nawas B, Frickhofen N, Gamm H, Beck J, ReinschLand al. Prevalence of bisphosphonate associated osteonecrosis of the jaws in multiple myeloma patients. Head Face Med 2010;6:11.

10-Agence Nationale de Sécurité des Médicaments et des produits de santé (ANSM). Lettres aux professionnels de santé. Recommandations sur la prise en charge buccodentaire des patients traités par bisphosphonates. 18décembre 2007.

11-Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B. American Association of Oral and Maxillofacial Surgeons (AAOMS) position paper on bisphosphonate-related osteonecrosis of the jaw - 2009 update. J Oral MaxillofacSurg2009;67Suppl 1:2-12.

12-Marx RE, Cillo JE Jr, Ulloa JJ. Oral bisphosphonateinduced osteonecrosis: risk factors, prediction of risk using serum CTx testing, prevention, and treatment. J Oral MaxillofacSurg 2007;65:2397-410.

13- Tarassoff P, Csermak K. Avascular necrosis of the jaws: risk factors in metastatic cancer patients. J Oral MaxillofacSurg2003;61:1238-9.

14- Agence Nationale de Sécurité des Médicaments et des produits de santé (ANSM). Information de sécurité. Lettre aux professionnels de santé. Acide zolédronique/pamidronate de sodium et ostéonécrose de la mâchoire. 7juillet 2005.

15-S L. Ruggiero, Th B. Dodson, J Fantasia, R Goodday, T Aghaloo, B Mehrotra, F O'Ryan, Medication-Related Osteonecrosis of the Jaw-2014 Update. American Association of Oral and Maxillofacial Surgeons

16-Fleisch H. Bisphosphonates: mechanisms of action. Endocrine Rev 1998 ; 19 : 80-100.

17- Lin JH. Bisphosphonates: a review of their pharmacokinetic properties. Bone 1996 ; 18 : 75-85.

18- Russell RG, Rogers MJ. Bisphosphonates: from the laboratory to the clinic and back again. Bone1999; 25 : 97-106.

19-Micheletti AM. Bisphosphonates. Info Dent 2005 ; 30 : 1793-6.

20-Y Torres, B Louvet, C Lacheretz, J-M Langlois, L Nawrocki Risque d'ostéonécrose des maxillaires associé à un traitement par biphosphonates dans l'enfance. Med Buccale Chir Buccale 2016;22:43-48

21-Cremers SCLM, Pillai G, Papapoulos SE. Pharmacokinetics/ pharmacodynamics of bisphosphonates: use for optimisation of intermittent therapy for osteoporosis. ClinPharmacokinet 2005; 44:551-570.

22- Papapoulos SE, Cremers SCLM. Prolonged biphosphonate release after treatment in children. N Engl J Med 2007;356:1075-1076.

23-Salino S, Bodard AG, Timour Q. Ostéoradionécrose et ostéonécrose des maxillaires aux bisphosphonates. Encyc Med ChirStomatol 28-865-A-10. Elsevier Masson SAS, Paris, 2010.

24-Mashiba T, Hirano T, Turner CH, Forwood MR, Johnston CC, Burr DB. Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib. J Bone Miner Res 2000;15:613-20.

25-Mavropoulos A, Rizzoli R, Ammann P. Different responsiveness of alveolar and tibial bone to bone loss stimuli. J Bone Miner Res 2007 ; 22 : 403-10.