Osteonecrosis of the jaw associated with bisphosphonate therapy in primary osteoporosis. Review of the literature

Background. The aim of this review was to study risk factors involved in osteonecrosis of the jaw after oral surgery in patients treated with bisphosphonates due to primary osteoporosis. Methods. In order to find relevant related publications, we conducted a systematic search in specialized (Co-chrane Database of Systematic Reviews, Trip Database) and general (Medline, Embase, Isi Web of Knowledge) bibliographical databases. The search strategy included the terms osteonecrosis, adults and oral surgery. It was limited to papers focused on human adults undergoing dentoalveolar surgery while being treated with bisphosphonates due to primary osteoporosis, which had been published in the English or Spanish languages between January 2006 and January 2012. Systematic reviews, meta-analyses, practice guidelines, randomized clinical trials and case report series were included. Results. Fourteen papers (case report series) including 43 cases of osteonecrosis of the jaw were selected. Jaw and extraction were the most frequent localization and dental procedure related to the lesions. Mean age of patients was 71.94 years, with lesions being more frequent among women. Alendronate was the bisphosphonate used in the majority of cases, with a mean duration of treatment before osteonecrosis of the jaw appeared of 48.25 months. Conclusions. Well-designed, prospective and retrospective studies are needed to evaluate the real weight of each of those factors considered to entail a potential risk of osteonecrosis of the jaw.