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Give an Account of the Pharmacology of Bisphosphonates and their Impact on the Delivery of Oral Surgery

Give an Account of the Pharmacology of Bisphosphonates and their Impact on the Delivery of Oral Surgery


The bisphosphonates are a group of drugs used for prevention and curing of bone resorption diseases, such as osteoporosis and cancer with metastatic bone, whether with or without hypercalcemia, cancer related with breast and prostate. It is also prescribed in Paget's disease and other disorders that cause bone fragility, such as chronic kidney disease treated with dialysis. Although very effective, in recent years we have seen an increase in the number of clinical cases in which the exploitation of bisphosphonates is related with the osteonecrosis of the jaw, which is why the dentist must be very alert on possible complications in patients who take them (Bagheri, 2012). In this sense, the collaboration will be critical to the oncologist and maxillofacial surgeon, in patients treated with bisphosphonates, and take steps to prevent osteonecrosis, such as the control of dental caries, the use of prostheses in atraumatic lingual and avoid invasive periodontal treatments and implants (Ruggiero et al., 2007). The bisphosphonates or diphosphonates molecules are indicated in the treatment of osteoporosis and in some cases of metastatic bone. Bisphosphonates were synthesized for the first time in Germany in 1865, and are used as limescale agents, but the first bisphosphonate therapy was introduced in the etidronate, in the late 1860's


Pharmacology of Bisphosphonates

Bisphosphonates belong to a group of drugs that has been developed since the 1980's for diagnostic and therapeutic purposes in bone and calcium metabolism disorders. Some compounds of this type are used in drugs for the treatment of osteoporosis used. They are also found useful use in the treatment of bone metastases and Fibrous dysplasia. In a study from 2009 was also by adding zoledronic acid (a substance from the group of bisphosphonates) to endocrine therapy for hormone-sensitive breast cancer achieved a longer recurrence-free survival. Bisphosphonates are also used in conjunction with 99m Technetium as a tracer in the nuclear medicine examination procedures skeletal scintigraphy. They are applied in a very low, not pharmacologically active dose. The bisphosphonate lexidronam is used in conjunction with the predominant beta emitter 153 samarium for palliative analgesic therapy in bone metastases used (radionuclide therapy) (Siris, 2009).

Bisphosphonates are an important class of drugs, useful for the treatment of metabolic diseases and cancer involving the skeletal system. Their mechanism of action is based on the ability to inhibit bone resorption mediated by osteoclasts (Drake et al., 2008). The most common bisphosphonates used in therapy are: alendronate, risedronate, ibandronate, pamidronate and zoledronate, compounds with high potency and selectivity.

Oral Bisphosphonates in the Treatment of Osteoporosis

The tendency of bisphosphonates to reduce bone resorption makes them useful in the treatment of osteoporosis, in which there is an imbalance between the processes of bone formation and resorption. Among the drugs available in Spain for oral administration, etidronate, alendronate and risedronate have been shown to reduce the incidence of ...