Epidemiology, clinical manifestations, risk-reduction and treatment strategies of jaw osteonecrosis in cancer patients exposed to antiresorptive agents

Osteonecrosis of the jaws (ONJ) is an adverse side event of bisphosphonatesand denosumab, antiresorptive agents that effectively reduce the incidence of skeletal-relatedevents in patients with metastatic bone cancer and multiple myeloma. Available data suggestthat 0–27.5% of individuals exposed to antiresorptive agents can develop ONJ. There isincreasing evidence that avoidance of surgical trauma and infection to the jawbones canminimize the risk of ONJ, but there are still a significant number of individuals who developONJ in the absence of these risk factors. Bone necrosis is almost irreversible and there is nodefinitive cure for ONJ with the exclusion, in certain cases, of surgical resection. However,most ONJ individuals are affected by advanced incurable cancer and are often managedwith minimally invasive nonsurgical interventions in order to control jawbone infectionsand painful symptoms. This article summarizes current knowledge of ONJ epidemiology,manifestations, risk-reduction and therapeutic strategies. Further research is needed inorder to determine individual predisposition to ONJ and clarify the effectiveness of availabletreatments.