Waseem Mehmood Nizamani, Ameet Kumar Jesrani, Mujtaba Khan, Kalthoum Tlili, Nadar Al Khuraish, Sara Waqar.
Bisphosphonates related osteonecrosis of jaw: a case report from middle east.
Pak J Radiol Jan ;29(2):129-33.

Bisphosphonates which are used in bone diseases like osteoporosis, multiple myeloma and metastatic bone diseases can lead to the most lethal complication of osteonecrosis of the jaw which particularly involves the mandible. (Aragon-Ching et al., 2009). The pathophysiology of BRONJ is not clear. However, it is considered that it is due to the defect in osteoblast and osteoclast activity as a result of which bone remodeling and wound healing is affected. It is also believed that dental procedures can lead to the BRONJ (Ikebe, 2013). Because bone cells are highly networked, the importance of multicellular interactions during the onset of these risk factors cannot be overstated. As such, this perspective addresses current research on the effects of BPs, mechanical load and inflammation on bone remodeling and on development of BRONJ. Our investigation has led us to conclude that improved in vitro systems capable of adequately recapitulating multicellular communication and incorporating effects of osteocyte mechanosensing on bone resorption and formation are needed to elucidate the mechanism(s) by which BRONJ ensues.

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