Guidelines for the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ)

Bisphosphonates are a class of agents used to treat osteoporosis and malignant bone metastases. Despite these benefits, osteonecrosis of the jaws has recently emerged as a significant complication in a subset of patients receiving these drugs. Based on a growing number of case reports and institutional reviews, bisphosphonate therapy may cause exposed and necrotic bone that is isolated to the jaw. This complication usually presents following simple dentoalveolar surgery and can cause a significant adverse effect on the quality of life for most patients. The pathogenesis for this complication appears to be related to the profound inhibition of osteoclast function and bone remodeling. This report will review the clinical signs and symptoms and risks associated with this new complication and provide a guideline for establishing a stage-specific diagnosis of BRON