Bisphosphonate Osteonecrosis in Clinical Practice: A Scoping Review with Special Emphasis on Pamidronate Therapy

Alper Sevinc

Clinic of Medical Oncology, Gaziantep Medicalpoint Hospital Mücahitler

^*Correspondance to: Alper Sevinc 

 PDF  Full Text Review Article | Open Access

Abstract:

Osteonecrosis of the Jaws (ONJ) is a rare but important complication of exposure to bisphosphonates, specifically in the oncology setting with high-dose/long-term usage. Bisphosphonate-induced ONJ, referred to as Bisphosphonate Osteonecrosis (BON), leads to adverse health outcomes such as pain, discomfort and poor quality of life and compromises the optimal benefit of the treatment. The exact pathophysiology of ONJ remains unclarified, in addition to absence of well-established risk factors and predictors of disease prognosis and outcomes. This scoping review aimed to address the properties and therapeutic indications of pamidronate amongst the other bisphosphates, and the clinical manifestations, pathogenesis and risk factors and management of BON, and to summarize the current evidence on the prevalence of ONJ in clinical practice as a function of treatment indication, and type and duration of antiresorptive agent as well as the bisphosphonate therapy after development of ONJ. Pamidronate seems to be associated with a much lower risk and a later onset of ONJ than zoledronate, possibly due to its less potent inhibitory effect on bone turnover and a weaker anti-resorptive activity. Nonetheless, the dose and duration of bisphosphonate is considered a major risk factor for the BON development, with more potent agents increasing the risk with shorter durations of exposure.

Keywords:

Bisphosphonates; Pamidronate; Osteonecrosis of the jaws; Bisphosphonate osteonecrosis; Clinical manifestation; Management

Cite the Article:

Alper Sevinc. Bisphosphonate Osteonecrosis in Clinical Practice: A Scoping Review with Special Emphasis on Pamidronate Therapy. Clin Oncol. 2024;9:2112..