Bisphosphonate-associated osteonecrosis of the jaw

Bisphosphonate-associated osteonecrosis of the jaw
Synonyms	BON of the jaw, bisphosphonate-related osteonecrosis of the jaw (BRONJ), bisphosphonate-induced osteonecrosis of the jaw (BIONJ)
Classification and external resources
MeSH	D059266
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Bisphosphonate-associated osteonecrosis of the jaw (BON, BONJ) is osteonecrosis of the jaw in a person with a history of bisphosphonate use who undergoes subsequent dental surgery. It may lead to surgical complication in the form of impaired wound healing following oral and maxillofacial surgery, periodontal surgery, or endodontic therapy.

An association between history of bisphosphonate use and osteonecrosis of the jaw after later surgery was detected for several years before the exact nature of the relationship (cause, pathogenesis) could begin to be understood, and it is still not entirely clear, although it has been nicknamed "bis-phossy jaw" based on its similarity with phossy jaw. There is no known prevention for bisphosphonate-associated osteonecrosis of the jaw. Avoiding the use of bisphosphonates is not a viable prevention on a general-population basis because the drugs have more benefit throughout the population (preventing osteoporotic fractures and treating bone cancers) than harm (BONJ).

Osteonecrosis, or localized death of bone tissue, of the jaws is a rare potential complication in cancer patients receiving treatments including radiation, chemotherapy, or in patients with tumors or infectious embolic events. In 2003, reports surfaced of the increased risk of osteonecrosis in patients receiving these therapies concomitant with intravenous bisphosphonate.Matrix metalloproteinase 2 may be a candidate gene for bisphosphonate-associated osteonecrosis of the jaws, since it is the only gene known to be associated with both bone abnormalities and atrial fibrillation, another side effect of bisphosphonates.

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