What is a BRONJ?
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an area of uncovered bone in the maxillo-facial region that did not heal within 8 weeks after identification by health care provider, in a patient who was receiving or had been exposed to Bisphosphonate Therapy (BPT) without previous radiation therapy to the …
What causes BRONJ?
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is thought to be caused by trauma to dentoalveolar structures that have a limited capacity for bone healing due to the effects of bisphosphonate therapy. See the image below. Exposed, necrotic bone in the left anterior maxilla.
How do you manage the BRONJ?
How is BRONJ Treated?
- Daily irrigation and antimicrobial rinses.
- Antibiotics to control infection.
- Surgical treatment to remove the necrotic bone may be advisable in more advanced cases.
How can BRONJ be prevented?
Prevention of BRONJ. Management of oral hygiene, patient education, and providing proper dental treatment are critical for preventing BRONJ [1]. However, whether a preventative drug holiday is useful during tooth extraction for patients receiving BPs remains controversial.
Is MRONJ and BRONJ the same?
The terms MRONJ (Medication related osteonecrosis of the jaw) and ARONJ (Antiresorptive drug related osteonecrosis of the jaw) presently replace the term BRONJ. MRONJ is similar to osteonecrosis, and is usually identified by the appearance of exposed bone in the oral cavity.
How common is BRONJ?
The prevalence of BRONJ was reported as 0.06% in long-term oral bisphosphonate receivers [17]. BRONJ due to oral alendronate sodium was found to be more frequent than formerly reported with a prevalence of approximately 4% (9 out of 208 patients) [18].
How is BRONJ diagnosed?
Patients may be considered to have BRONJ if all of the following three characteristics are present: 1. Current or previous treatment with a bisphosphonate; 2. Exposed, necrotic bone in the maxillofacial region that has persisted for more than eight weeks; and 3. No history of radiation therapy to the jaws.
Why does MRONJ occur?
MRONJ is an adverse reaction which can occur as a result of medicines used to treat cancer and osteoporosis. Some medications which induce these effects are bisphosphonates, denosumab and antiangiogenic agents.
What is bio phosphonate?
Bisphosphonates are a group of drugs that work by slowing bone loss. They reduce the risk of hip and spine fractures. Bone renewal is a slow process, but in many people an increase in bone density can be measured over five years of treatment.
What are examples of bisphosphonates?
Alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva) are available orally. The former two agents can be taken daily or weekly; the latter two agents can be taken daily or monthly. Pamidronate (Aredia), ibandronate (Boniva) and zoledronic acid (Boniva) are available intravenously.
What drug class is alendronate?
Alendronate is in a class of medications called bisphosphonates. It works by preventing bone breakdown and increasing bone density (thickness).
What drugs are bisphosphonates?
Osteoporosis Medications (Bisphosphonates)
- Risedronate (Actonel)
- Alendronate (Fosamax)
- Ibandronate (Boniva)
- Zoledronic Acid (Reclast)
- Pamidronate (Aredia)
- Etidronate (Didronel)
What medical conditions cause MRONJ?
Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious complication that can damage the jawbone. It can occur after treatments like pulling a tooth or treating severe gum disease. It affects some people who are taking or have taken medications to protect bones.
How common is MRONJ?
The reported incidence of MRONJ varies, but it is generally considered to be between 1% and 10% of patients taking IV bisphosphonates for the management of bone metastatic disease and between 0.001% and 0.01% in patients taking oral bisphosphonates for the management of osteoporosis.
What are bisphosphonates?
Bisphosphonates are drugs that help prevent or slow down bone thinning (osteoporosis). They can help to treat some types of cancer that cause bone damage. You might hear bisphosphonates called bone hardening or bone strengthening treatment. They are also a treatment for high levels of calcium in your blood.
Which drugs belong to the bisphosphonate class?
The following drugs belong to the bisphosphonate family:
- Actonel or Altevia (risedronate)
- Fosamax (alendronate)
- Boniva (ibandronate)
- Reclast or Zometa (zoledronic acid)
Is alendronate a bisphosphonate?
What is another name for alendronate?
Alendronate is commonly known by the brand name Fosamax®. Fosamax® is a bisphosphonate and is used in the treatment of osteoporosis. Fosamax® decreases the rate bone cells are absorbed. This reduced absorption allows the body to increase bone density, which in turn reduces the risk of fracture.
Which of the following is an example of a bisphosphonates?
Bisphosponates such as risedronate (Actonel), alendronate (Fosamax), ibandronate (Boniva), zoledronic acid (Reclast), and pamidronate (Aredia) are used to treat and prevent osteoporosis—or, bone thinning—which occurs when the bones lose calcium and other minerals that help keep them strong and compact.