Mew Dimensional Staging of Bisphosphonate-Related Osteonecrosis of the Jaw Allowing a Guided Surgical Treatment Protocols Long-Term Follow-Up of 266 Lesions in Neoplastic and Osteoporotic Patients from the University of Bari

摘要

Bisphosphonates (BPs) are synthetic drugs analogues of inorganic pyrophosphate that can be divided into two groups, nitrogen-containing and non-nitrogen-containing BPs, with different mechanisms of action on osteoclasts [1, 2]. These compounds were originally licensed for the management of skeletal complications of malignancy, including advanced breast cancer and multiple myeloma, but now they are also the drugs of choice in the management of other bone disorders including osteoporosis, cancer-induced hypercalcaemia, Paget's disease, osteogenesis imperfecta [3-5], primary and secondary hyperparathyroidism, and other conditions that feature bone fragility [1]. The most serious side effect of BPs therapy is the bisphosphonate-related osteonecrosis of jaw (BRONJ), firstly described in 2003 by Marx [6]. BPs decrease both bone reabsorption and formation, leading to increased bone fragility and fractures caused by inability to replace old bone by young bone and to repair Microtracks [7]. According to the most widely used definition, given by the American Association of Oral and Maxillofacial Surgeons (AAOMS) and modified by Colella et al., BRONJ is the presence of exposed or otherwise necrotic bone for at least 8 weeks in patients with exposure to BPs and no history of radiotherapy to the jaw [6, 8, 9]. BRONJ can occur in patients receiving