Anti-resorptive Drugs and their Impact on Maxillofacial Bone among Cancer Patients
This article aims to give an overview on etiology, diagnosis and treatment options of osteonecrosis of
the jaw bone among cancer patients receiving anti-resorptive drugs (ARDs). The physiologic bone function of
continuous resorption and buildup is modified by the use of ARDs. Although ARDs proved to reduce pain and to
improve the quality of life in patients with metastasizing bone disease, side effects such as medication related
osteonecrosis of jaw bone (MRONJ) have been frequently reported since ARDs were firstly introduced. The new
generation of ARDs such as Denosumab is associated with the same incidence of MRONJ among cancer patients. The etiology of
MRONJ is not entirely understood and many hypotheses have been proposed. ARDs can modify the hard tissues directly by
accumulation in the bone, or indirectly by suppression of the osteoclasts, inhibition of angiogenesis and vascularity. Some ARDs such as
Bisphosphonates have reportedly the capacity to interfere directly and indirectly with the bone physiology. MRONJ can be a debilitating
disease with non healing freely exposed bone in the oral cavity in patients, who already suffer from a primary cancerous disease.
Knowledge of MRONJ as a potential side effect of ARDs is crucial for health professionals treating patients with bone modulating drugs.
Keywords: Anti-resorptive drugs, bisphosphonates, denosumab, jaw necrosis, osteoporosis.
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