Introduction
The term “bisphosphonate-associated bone necrosis” refers to a disease of the jawbone in which the bone substance dies off. Accordingly, a spontaneous degradation process of the bone tissue in the jaw area takes place. In recent studies it was found that this form of bone loss occurs particularly frequently in patients who have previously taken bisphosphonate-containing medication.
Bisphosphonates belong to a group of drugs that strongly influence the metabolism of bone. In this context, they have an inhibitory effect on important cells of bone tissue. Especially in the treatment of osteoporosis and breast or prostate cancer, there are many possible applications for these drugs.
In osteoporosis therapy, the inhibitory effect of the bisphosphonates on the osteoclasts (bone-destroying cells) is exploited; the ingredients of the drugs form a barrier between the bone surface and the osteoclasts. As a result, the degradation processes can be effectively reduced. Furthermore, an increase in bone density can be achieved in the course of bisphosphonate therapy by activating osteoblasts (bone-building cells).
Cause
For what reason medicines, which prevent degradation processes of the bone in the major part of the body, cause an opposite effect in the jawbone in particular, has not been researched exactly so far. It is assumed that bisphosphonate-associated bone necrosis develops in the course of dental or maxillofacial surgery with exposure of the jawbone. For this reason, maxillofacial surgery should be carefully considered when taking bisphosphonates. However, the assumption that there is a relationship between maxillary surgery and bisphosphonate-associated bone necrosis has not been substantiated to date.
Symptoms
The first sign of bisphosphonate-associated bone necrosis is the appearance of swelling and redness within the oral cavity and around the cheeks. Furthermore, especially at the beginning of this disease, steadily increasing tooth loosening and inflammation in the toothed sections of the jaw can be observed. Most affected patients report moderate to severe pain and a loss of sensitivity in the diseased jaw area at an advanced stage of bisphosphonate-associated bone necrosis.
The secretion of purulent secretions from the gum pockets and/or the formation of abscesses are also possible signs of bisphosphonate-associated bone necrosis. In case of disease, the patient usually shows a very classic jaw appearance. Exposed, yellowish-brown bone sections with a very rough surface structure are visible. The symptoms of bisphosphonate-associated bone necrosis are therefore very unspecific and can also occur in connection with other diseases of the periodontium and/or the oral cavity.
