Incidence of bisphosphonate-related osteonecrosis of the jaw (Bronj) based on treatment duration and symptoms in osteoporosis patients

Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) is a serious adverse effect associated with bisphosphonate therapy, commonly used for osteoporosis treatment. While bisphosphonates effectively reduce fracture risks, prolonged use has been linked to an increased incidence of BRONJ. This systematic review aims to analyze the incidence of BRONJ based on treatment duration and symptoms in osteoporosis patients, highlighting risk factors and clinical manifestations. A structured literature search was conducted using major electronic databases, including EBSCO, PubMed, and Springer Link, following the PRISMA guidelines for study selection. Findings indicate that the duration of bisphosphonate therapy significantly influences BRONJ occurrence, with patients undergoing treatment for more than five years exhibiting a higher incidence of necrotic jaw lesions. BRONJ symptoms range from mild jaw discomfort to severe osteonecrosis, characterized by exposed bone, infections, and pathological fractures. The progression of symptoms is often subtle in the early stages, making early diagnosis challenging. This review also identifies other contributing factors, such as invasive dental procedures, underlying oral infections, and systemic health conditions, which exacerbate BRONJ severity. Despite extensive research on bisphosphonate therapy, there remains no consensus on the optimal duration of treatment for osteoporosis patients to minimize BRONJ risks while maintaining therapeutic benefits. Additionally, early-stage BRONJ symptoms often go undetected, leading to delayed intervention and worsened patient outcomes.