Bisphosphonates and osteonecrosis of the jaws: clinical and forensic aspects.

Abstract

Bisphosphonates are widely accepted as the preferred treatment for skeletal-related disorders with increased bone turnover, such as osteoporosis, Paget's disease of bone, and malignancy-related conditions. However, the use of these medications can lead to a potentially severe complication known as medication-related osteonecrosis of the jaw (MRONJ), whose prevalence is expected to increase. This paper aims to provide a comprehensive review of the current knowledge in the pathophysiology, diagnosis, prevention, and other relevant forensic and clinical aspects of MRONJ while synthesizing state-of-the-art information on bisphosphonates and introducing a possible differential diagnosis: osteonecrosis associated with krokodil consumption. MRONJ prevention relies on a multidisciplinary approach and is critical because truly effective treatments are lacking. This therapeutic challenge is due in part to uncertainty regarding this condition's pathophysiology. Therefore, further research on the etiology and site specificity of MRONJ is encouraged.