Osteonecrosis of the jaw: A spectrum disorder?

Gayathri Subramanian, Devendra Bajaj, Shankar Iyer, J. Christopher Fritton, Samuel Y.P. Quek

Research output: Chapter in Book/Report/Conference proceedingChapter


The objective of this commentary is to present an updated perspective on the etiology, pathogenesis, diagnosis that should guide management of osteonecrosis of the jaw (ONJ). We also develop a logical case for treating ONJ with recombinant parathyroid hormone 1-34 (teriparatide, hPTH 1-34, Forteo®) The currently accepted model for ONJ development is based on an association of pathogenesis with deregulation of osteoclast (OC) and vascular functions. Deregulated OC functionality, combined with the shutdown of small blood vessels is believed to result in static or adynamic necrotic bone, which is resistant to the usual bone repair mechanism. The current consensus by experts in the field requires that necrotic bone persist for a pre-defined duration of time before being diagnosed as ONJ. [1] We speculate that ONJ may be recognized much earlier than currently thought if the pathogenesis is viewed slightly differently. We have proposed that ONJ is the consequence of an exaggerated imbalance in bone remodeling caused by detrimental responses to potent antiresorptive agents in a susceptible host. [2, 3] We speculate that the molecular events that lead to the failure in local bone remodeling starts much earlier in time than the current definition of ONJ. If diagnosis could be made at an earlier phase in the pathology, it might be possible to protect the integrity of the bone remodeling process and slow the growth of the early lesion. Early diagnosis and management creates an opportunity for potentially more effective management. [2] We also speculate that ONJ may be viewed as a single entity with diverse etiology, ranging from physical agents such as irradiation (osteoradionecrosis), and anti-resorptive therapy such as bisphosphonates or denosumab, to anti-angiogenic agents such as sunitinib or bevacizumab. ONJ may well represent a spectrum of events that result from and perpetuate deregulated local bone remodeling.

Original languageEnglish (US)
Title of host publicationOsteonecrosis
Subtitle of host publicationDiagnosis, Treatment and Management
PublisherNova Science Publishers, Inc.
Number of pages44
ISBN (Print)9781622572823
StatePublished - Dec 2012

All Science Journal Classification (ASJC) codes

  • Medicine(all)


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