Systematic Review of Bisphosphonates and Osteonecrosis of the Jaw

Introduction: Bisphosphonates commonly prescribed for bone-related conditions but are associated with a side effect called osteonecrosis of the jaw (ONJ). This systematic review investigates ONJ incidence and bisphosphonate types among patients. Methods: Comprehensive systematic search of medical literatures identified five relevant studies. These studies reported 42 ONJ cases in bisphosphonate-treated patients, providing data on affected jaw regions, medication usage, and primary diagnoses. Results: Mandible was the most frequently affected osteonecrosis (40 cases), followed by maxilla (9 cases) and both mandible and maxilla (3 cases). Pamidronate was the most commonly associated medication (12 cases), followed by combinations of pamidronate and zoledronic acid (15 cases), zoledronic acid alone (10 cases), and other bisphosphonate combinations (1 case). Primary diagnoses were varied, with myeloma being the most common (18 cases), followed by breast cancer (7 cases), prostate cancer (1 case), renal cancer (1 case), and other diagnoses. Conclusion: There is a risk of ONJ in bisphosphonate-treated patients. Pamidronate and zoledronic acid, often used in combination, were the most frequently implicated medications. Patients with myeloma and breast cancer appear particularly susceptible. Monitoring is crucial considering the risks and benefits of bisphosphonate therapy, particularly in high-risk populations. Keywords: Bisphosphonates; ONJ; Pamidronate; Zoledronic acid