Subclinical Oral Bisphosphonate-related Osteonecrosis of the Jaw: Systematic Review of the Literature and an Additional Case

Introduction: Bisphosphonate-related osteonecrosis of the jaw (BRONJ), which has few studies despite the increase in the number of cases published in the literature in the last decade, is a rare complication related to the use of oral bisphosphonates. The objectives of this study are to perform a systematic review of the literature on cases of osteonecrosis of jaw associated with the use of oral bisphosphonates in the treatment of osteoporosis and to identify the main clinical characteristics and risk factors related to the cases described in the literature. In addition, a case of subclinical osteonecrosis of jaw associated with the use of oral bisphosphonate for a short period of time was reported.

Methods: A systematic review was conducted to identify cases of BRONJ among individuals using oral bisphosphonate. The survey included articles published in English from the period January 1950 to October 2016 in the PubMed and Cochraine databases.

Results: 49 published articles were selected, totalling 284 patients diagnosed with BRONJ. The mean age of the patients was 72.68 years and 96% were female. Alendronate was the most prescribed bisphosphonate, being used by 88.08% of the patients and osteoporosis/osteopenia was the indication of the treatment in 95% of the cases. The median duration of therapy until diagnosis of osteonecrosis of jaw was 5.23 years; 12.38% were on corticosteroids use at diagnosis and 82% of the patients performed some dental procedure preceding the onset of lesions. The mandible was the site most affected (74.64% of the cases) and 57,81% of the cases were in stage 2 at diagnosis. The most frequent associated conditions were: hypertension, corticosteroid use rheumatoid arthritis and diabetes mellitus, and 28% of cases occurred during the first 3 years of therapy.

Conclusion: Bisphosphonate-related osteonecrosis of the jaw is a rare disease which is associated with dental procedures and systemic conditions, and may occur at any time during therapy.