1 | INTRIDUCTION
Bisphosphonates are a group of medications prescribed for conditions
such as osteoporosis and malignant bone metastasis. Bisphosphonates
caused a great progress in treatment of musculoskeletal disorders such
that they are currently among the most commonly used medications for
clinical treatment of osteoporosis. Moreover, some reports are available
regarding their effective role in management of some other skeletal and
joint diseases such as the Paget’s disease, bone metastasis,
developmental anomalies, dysplastic fibrosis, Charcot arthropathy,
sympathetic dystrophy, aseptic osteomyelitis, multiple myeloma,
osteopenia, and osteogenesis imperfecta.1, 2
Despite the numerous advantages of bisphosphonates, recently,
osteonecrosis of the jaw was proposed as a major complication developing
in patients taking bisphosphonates. Bisphosphonate-related osteonecrosis
of the jaw (BRONJ) was first described by Marx in 2003; since then,
number of reported cases of BRONJ has increased.3-6The exact mechanism of BRONJ has not yet been clarified. BRONJ is
characterized by an exposed area of jawbone, remaining for more than 8
weeks in patients who have not undergone radiotherapy but have a history
of, or are currently taking bisphosphonates.7Bisphosphonates are deposited in bone and are integrated into the bone
matrix. During the bone remodeling process, bisphosphonates are taken up
by osteoclasts. In their cytoplasm, bisphosphonates inhibit the activity
of osteoclasts and induce their apoptosis. Bisphosphonates inhibit the
osteoclastic bone resorption, with the help of osteoblasts. They also
have anti-angiogenic properties. Under such circumstances, the bone
turnover greatly decreases, and the bone undergoes slight physiological
remodeling over time. Thus, the bone becomes brittle and cannot repair
the tiny fractures that occur during daily activities.
This study aimed to assess the knowledge level of physicians prescribing
bisphosphonates (oncologists, orthopedists, rheumatologists, and
endocrinologists) in Tehran city about dental considerations in such
patients and prevention and treatment of BRONJ in 2019.