A review of pathophysiological mechanism of Bisphosphonate-related osteonecrosis of the jaw

Kwon,  Tae-Geon

J Korean Dent Assoc > Volume 52(4); 2014 > Article

The Journal of The Korean Dental Association 2014;52(4):192-202.
Published online April 30, 2014.

임상가를 위한 특집 1 - 비스포스포네이트 관련 골괴사의 병태생리학적 기전에 대한 검토

권대근

경북대학교 치의학전문대학원 구강악안면외과학교실

A review of pathophysiological mechanism of Bisphosphonate-related osteonecrosis of the jaw

Tae-Geon Kwon

Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University

Abstract

Bisphosphonate(BP) significantly influence the hone remodeling process. Increasing number of patients with osteoporosis and metastatic bone disease need high dose or long term bisphosphonate therapy. Major adverse effect is jaw bone necrosis and now the bisphosphonate-related necrosis of the jaw(BRONJ) is the major concern of dental practitioner. This study intended to perform the review of the current understandings concerning the pathophysiology of BRONJ. Even though pathophysiological mechanism of BRONJ is not clearly elucidated but now suggested as largely two different concepts; so-called "inside-out" or "outside-in" theory. Inside-out theory emphasize the osteonecrosis of the jaw is the initial major event and subsequent infection and inflammation is the second event that accompanies bone exposure and death of overlying mucosa. However, in "outside-in" theory, infection or inflammation initiated by traumatized oral epithelium is the major event of BRONJ. Both theory would be partially explain BRONJ. Recent research reveals the immune modulating effect and influence of microcrack accumulation by BP. These findings and those of others might explain the missing part of outside-in theory.

Key Words: Bisphosphonate-related osteonecrosis;infection;soft tissue toxicity;