Bisphosphonate-associated Osteonecrosis (BON) of the jaws: a possible treatment?

Management of bisphosphonate-associated osteonecrosis (BON) of the jaws is currently a very topical subject. At present, there is no effective treatment for this condition. Several authors have recommended that prevention, when possible, of BON in patients at risk is the gold standard. In established cases, bisphosphonate therapy should not be discontinued; aggressive surgery of bone defects is mostly counterproductive, and furthermore, hyperbaric oxygen is of no benefit to patients affected with BON. In accordance with these restrictive therapy guidelines, the conclusion has been that these patients must and can live with some exposed bone in the oral cavity. [1], [2] and [3] Intermittent or continuous antibiotic therapy (penicillin V-K 500 mg, 4 times daily in association with metronidazole 500 mg, 3 times daily) has been shown to be beneficial as symptomatic treatment. [1] and [2] However, bisphosphonates are commonly prescribed (both intravenously and orally) for a range of conditions including osteoporosis, Paget’s disease, multiple myeloma, hypercalcemia of malignancy, and bone metastases of malignancies (such as breast and prostate cancer). Therefore, patients receiving these drugs are characterized by different systemic metabolic conditions, life expectancy, and ability to bear the side effects of these prolonged (and sometimes permanent) therapeutic antibiotic schemes. In addition, patients affected by BON of the jaws often develop recurrence of bone defects, with variable timing, in spite of the antibiotic treatments. Thus, it would be useful to find an alternative treatment of this condition.