Osteonecrosis Related to the use of Osteoporosis Medications: An Integrative Literature Review

Abstract

Aims: Understand the relationship between bisphosphonates used in the treatment of osteoporosis and mandibular osteonecrosis, its outcomes, and implications for patient management, seeking to understand the best strategies for preventing and managing this condition. Study Design:  Integrative literature review. Methodology: The research methodology was outlined as exploratory and qualitative, aiming to provide a deeper understanding of the problem under study and generate hypotheses. Works published in the last 10 years (2014 to 2024) were used, including books, articles, periodicals, and online resources. For the selection of the sample, priority was given to works indexed in national and international journals, available in full. The electronic search was conducted in databases such as Latin American and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Scientific Electronic Library Online (SciELO). The descriptors used were "Antiresorptive", "Bisphosphonate", "Mandible" and "Bone necrosis", registered in the Health Sciences Descriptors (DeCS), combined with the Boolean operators "AND" and "OR". The inclusion criteria for the selection of articles were to be original, addressing the theme of the study, to be indexed in the selected databases, written in Portuguese or English, and to be free of charge. Studies that were not related to the theme, duplicates and that did not fit into the proposed analysis period were excluded. Results: Through the studies surveyed, an association between the incidence of osteonecrosis and the use of osteoporosis drugs, such as bisphosphonates, especially osteonecrosis of the jaws (ONJ), was observed. Bisphosphonates, widely used in the treatment of osteoporosis, inhibit bone resorption, but their long-term use is associated with complications, including ONJ. Risk factors such as advanced age, long-term use of medications, comorbidities such as diabetes, and genetic predisposition have been identified. Conclusion: Management of ONJ involves conservative therapies and surgical procedures, which are especially effective when the condition is diagnosed early. On the other hand, therapeutic alternatives, such as photodynamic therapy, are being investigated, highlighting the need for controlled clinical trials to determine their efficacy.