Bifosfonati: note storiche, terapie e protocolli

Introduction

For years bisphosphonates have been used to treat osteopenic disorders and breast and prostate cancer. Along with their therapeutic effects, these drugs have also significant collateral effects, and their use has been associated with osteomyelitis and osteonecrosis of the jaw (ONJ). Dentists need to be familiar with this disorder since it involves the orofacial region. The purpose of this article is to provide an overview of bisphosphonates, their mechanism of action and their therapeutic applications. We also review guidelines for dentists on the prevention and management of ONJ.

Materials and methods

We reviewed articles published in English between 1999 and 2009 whose titles included the following terms: “osteonecrosis of the jaw”, “bisphosphonate”, “alendronate”, “pamidronate”, or “zolendronate”. The review included case reports of bisphosphonate-associated ONJ in adults. The data reported included patient age, sex, and medical and dental history, as well as characteristics of the bisphosphonate treatment (drug used, dose, route of administration, duration of treatment).

Results

Our research revealed that the most common site of bisphosphonate-associated osteonecrosis is the mandible, followed by the maxilla. Most patients were women >50 years of age, and 80% of the patients had undergone dental surgery at the site of the ONJ. There was no clear correlation between the duration of bisphosphonate treatment and the development of ONJ.

Conclusions

Millions of patients are receiving bisphosphonates for the treatment of osteoporosis, and ONJ is one of the most common complications observed in such patients. The typical patient with ONJ is a female, >50 years of age, with a history of dental surgery or trauma. Dentists play a primary role in the treatment of ONJ associated with the use of bisphosphonates. However, definitive conclusions on the causal relation between oral bisphosphonate use and ONJ are not possible at this time because these drugs are still being investigated and the results emerging from different studies are sometimes discordant.