Anti-osteoclastic drugs and their impact on maxillofacial and orthopedic bone biology, disease, diagnosis, prevention, surgery, and treatment modalities (ARONJ)

Bisphosphonates (Alendronate, Zolendronate, Pamidronate and others) and additional anti-osteoclastic drugs such as RANKL inhibitors (Denosumab) are among the most prescribed drugs in the world today.

26 million prescriptions for Alendronate in the US alone are used for treatment of postmenopausal osteoporosis and 250,000 patients with metastatic bone cancer are treated with high dose intravenous bisphosphonates.

These drugs have been noted to have profound influences on oral and orthopedic health including exacerbation of dental diseases, osteonecrosis of the jaw requiring ablation, spiral fractures of the femur, bone pain, and spinal and other foramenal stenosis These medications have also been associated with a marked decrease in femoral neck fractures, compression fractures of the spine and other osteoporotic fractures such as wrist and humerus.

Past call: 2016

Bisphosphonate-induced Osteonecrosis of the Jaws (BRONJ)

Bisphosphonate treatment induces cell death in osteoclast populations, slowing bone loss in osteoporosis and impeding the spread of certain cancers (bone metastases), but is also associated with an increased risk of osteonecrosis of the jaw, especially when combined with dental surgery. Bisphosphonate treatment may be received intravenously (94% of BRONJ cases) or orally (6%). These osteonecrotic symptoms have only been observed in the craniofacial region, probably because the local turnover of bone is relatively high; anything that inhibits this normal function will be especially pronounced here.

Past call: 2011