Osteonecrosis: what does it mean? One condition partly caused by bisphosphonates—or another one, preferably treated with them?

Osteonecrosis: what does it mean? One condition partly caused by bisphosphonates—or another one, preferably treated with them?

Abstract

Acta Orthopaedica 2006; 77 (5): 693–694 693 Editorial Osteonecrosis: what does it mean? One condition partly caused by bisphosphonates—or another one, preferably treated with them? In both the scientific and the lay press (Kolata 2006), there have recently been many warnings about something called osteonecrosis of the jaw, a condition apparently related to cancer and chemotherapy in combination with bisphosphonates (Ruggiero et al. 2004, Marx et al. 2005). It is rare in relation to the widespread use of bisphosphonates, but has led to recommendations to pay attention to oral status in connection with cancer therapy when the bone contains, or will contain, bisphosphonates (Marx et al. 2005). This condition appears to start with a wound (dental extraction, peridontitis) exposing the jawbone, which then contracts a chronic Actinomyces infection (Hansen et al. 2006). It is often speculated that the condition is the end stage of a development that starts with bone necrosis—caused in some unknown way by the bisphosphonate; hence its name. However, until proven otherwise, any pathogenetic speculation should regard the bone as living before it is infected, because living osteocytes are often seen within the lesion (Hansen et al. 2006). Moreover, the pathogenesis must involve an impaired