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.