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Ann R Coll Surg Engl. 2009 July; 91(5): 446.
PMCID: PMC2758468

Oral & Intravenous Bisphosphonate-Induced Osteonecrosis of the Jaws: History, Etiology, Prevention, and Treatment

Reviewed by John Lowry

Oral & Intravenous Bisphosphonate-Induced Osteonecrosis of the Jaws: History, Etiology, Prevention, and Treatment ROBERT E MARX 
EXTENT P/H 160 pages, Paperback 
PRICE/ISBN £58.00, 9780867154627 
PUBLISHER Quintessence Publishing (New Malden), 2007 
REVIEWER John Lowry 
STAR RATING ****  

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) was initially recognised and reported in the literature in 2002. It has since come under increasing scrutiny especially as it affects not only patients receiving intravenous bisphosphonates for cancer-related conditions unrelated to radiotherapy but also those on oral preparations for osteoporosis.

Although there is an increasing volume of papers, this is the first textbook published on the topic. The author is Professor of Surgery and Chief of the Division of Oral and Maxillofacial Surgery at the University of Miami. He is well recognised in the specialty and over recent years has lectured and written widely on surgical issues related to bone pathology, including the use of hyperbaric oxygen following radiation therapy. In a jointly authored, award-winning textbook on oral and maxillofacial pathology he in fact contributed to the first identification of BRONJ. This was subsequently analogised by other authors to the industrial disease referred to as phossy jaw reported over 100 years ago in phosphate miners and match factory workers in the US and the UK.

The book endeavours to cover the history, aetiology, prevention and management of BRONJ and following a philosophical preface reviewing the discovery of a new disease and three stages of a scientific theory, is set out in seven chapters. These sequentially cover the description and history of the condition, pharmacokinetics of bisphosphonates, and medical indications for their use, and includes a comparison of BRONJ with osteopetrosis as a genetic analogue. Risks, prevention and management are considered separately for intravenous and oral administration of the drug while the final chapter presents 12 case reports, each of which is well illustrated. The text concludes with a valuable glossary and an effective index.

Technically, the text is tastefully presented, the pages of each chapter having a colour-coded stripe along the edge for easy reference to the main sections. The soft cover is attractive and depicts the periosteal blood supply with osteoblastic deposition of new bone while osteoclasts are failing to resorb bone effectively and are dying as a result of ingesting bisphosphonate.

The book clearly accomplishes its stated aim of educating colleagues in the profession on the current knowledge and understanding of this relatively newly described condition. There are two points of minor criticism in relation to potential confusion on both classification of the disease and also reliance on serum CTX as a reliable marker of bone turnover to guide the relative risks of surgery. In the opinion of the reviewer it should therefore be read in parallel with a number of review articles and guidelines that are now emerging. It would be helpful reading across a wide range of colleagues including trainees preparing for postgraduate dental and surgical examinations and also the maxillofacial and orthopaedic intercollegiate specialist fellowships. In addition the preventative aspects are of importance to dentists and doctors in primary care while the background and clinical components are also valuable for specialists in a number of disciplines.


Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England