, Volume 13, Issue 4, pp 479-480
Date: 13 Aug 2009

“Fatigue” having a role in the pathogenesis of osteonecrosis of the jaws

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Sir,

In 2002, 9 months after zoledronic acid received Food and Drug Administration (FDA) approval for the prevention of cancer-related skeletal events, the FDA received clinicians’ reports describing patients with cancer who had developed a severe and unusual complication, osteonecrosis of the jaw (ONJ), which was initially ascribed to being a later chemotherapy effect [1]. To date, there is still a lack of knowledge of pathogenesis, prevention and treatment regarding ONJ [2].

In 2008, another probable complication has been attributed to bisphosphonate use: Atypical fractures of the femoral diaphysis have been reported [3, 4] in patients with history of chronic alendronate use. Furthermore, bisphosphonate use has been associated with a unique X-ray pattern in sub-trochanteric/shaft fractures [5]. Based on this evidence, a recent review suggested that both ONJ and atypical fractures of the femoral diaphysis may be manifestations of “fatigue” in human bone. In material science, “fatigue” i ...