Antiresorptive drug-related osteonecrosis of the jaws, literature review and 5 years of experience

  • S. Bernardi
  • M. Di Girolamo
  • S. Necozione
  • M. A. Continenza
  • T. Cutilli
Original Article



Bisphosphonate drug therapy provides benefits in the case of osteoporosis and carcinomas metastasizing to the bones, but it exposes patients to important side effects. The aim of this study was to investigate the incidence and the appropriate surgical treatment of bone lesions and fractures due to antiresorptive drug-related osteonecrosis of the jaws (ARONJ).


Patients presenting with osteonecrosis lesions of the jaw, who were referred to the Maxillo-Facial unit of the University of L’Aquila, were considered for inclusion. Grade of the lesion and treatment choice was recorded for each patient. Descriptive statistics were calculated and the data were analysed with Chi-squared tests. A representative case of a fracture reduction with a supra-periostal approach is reported.


Among the 165 patients with ARONJ lesions, 112 were female and 53 were male. In total, 115 patients received intra-venous bisphosphonate therapy and 50 received oral bisphosphonate therapy. Five stage 2 lesions, three stage 2 lesions and two stage 3 lesions were not a consequence of dental procedures. Eighteen surgical bone excisions were performed and four pathological fractures were reduced. In one case (the reported one), the combined use of platelet-rich plasma and the supra-periostal approach leads to a successful 1-year follow-up.


ARONJ lesions are a type of pathological bone disease affecting the jawbones. The pathology pathway remains a controversial and frequently discussed topic. A surgically conservative strategy seems to be the best way to assure a comfortable quality of life to those patients negatively affected by this condition.


Biphosphonates Antiresorptive agent Osteonecrosis of the jaw Osteoporosis 


Author’s contribution

Sara Bernardi and Tommaso Cutilli contributed to study conception and design; Mattia Di Girolamo contributed to data acquisition and writing of article; Stefano Necozione provided statistical analysis and review; and Maria Adelaide Continenza Sara Bernardi and Tommaso Cutilli contributed to editing, reviewing and final approval of article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Consent for the publication of the case report and any additional related information was obtained from the patients involved in this study.


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Copyright information

© Istituto Ortopedico Rizzoli 2018

Authors and Affiliations

  1. 1.Anatomy Division, Department of Life, Health and Environmental SciencesUniversity of L’AquilaL’AquilaItaly
  2. 2.Department of Life, Health and Environmental SciencesUniversity of L’AquilaL’AquilaItaly
  3. 3.Maxillo-Facial Surgery Unit, Department of Life, Health and Environmental SciencesUniversity of L’AquilaL’AquilaItaly

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