Insight into Bisphosphonate-associated Osteomyelitis of the Jaw: Pathophysiology, Mechanisms and Clinical Management

Background: Bisphosphonates are widely used for the treatment of bone diseases. Bisphosphonate-associated osteomyelitis of the jaw (BAOMJ) affects 1 per 100,000 patients-treated years for non-cancer bone diseases and approximately 1 - 2% of cancer patients treated with bisphosphonates.

Results: The mechanism of sustaining osteonecrosis of the jaw (ONJ) is unclear, but several predisposing factors have been identified. The dosage, frequency of administration and the duration of bisphosphonate therapy may precipitate BAOMJ.

Conclusion: Evidence supports immune and infectious etiology for BAOMJ. Hence, the term BAOMJ seems more appropriate than ONJ or BAON (bisphosphonate-associated ONJ). Bisphosphonates are the mainstay of therapy for osteoporosis. Cancer patients receive 10 - 15 times higher doses of bisphosphonates at a greater frequency per year than osteoporosis patients. This may trigger BAOMJ in such patients. The benefits of bisphosphonate therapy outweigh the incidence and risks of BAOMJ. Bisphosphonates show a temporal association with BAOMJ and no direct causal relation with ONJ.