Efficacy and Safety of Bisphosphonates in Chronic Non-bacterial Osteomyelitis of the Mandible: A Systematic Review.

Chronic non-bacterial osteomyelitis (CNO) of the mandible, often called diffuse sclerosing osteomyelitis (DSO) in Maxillofacial and Dental literature, is a rare condition characterized by sterile osteomyelitis affecting the mandible. This condition is part of the chronic recurrent multifocal osteomyelitis (CRMO)/synovitis, acne, pustulosis, hyperostosis, and osteomyelitis (SAPHO) spectrum. However, because mandibular involvement may present as unifocal disease, it deserves special attention. Unfortunately, the rarity of this disorder, along with a general lack of awareness, has led to numerous unnecessary and ineffective surgical interventions in the past. While some of these lesions may resolve on their own with only symptomatic management with NSAIDs, there is increasing evidence that lesions refractory to NSAIDs can respond well to bisphosphonates (BPNs). The authors conducted a systematic review following PRISMA guidelines to investigate the effectiveness of BPNs for CNO/SAPHO of the mandible and to assess potential adverse reactions, particularly medication-related osteonecrosis of the jaw (MRONJ). In this review, we identified one randomized controlled trial and nine case series describing the use of bisphosphonates in treating mandibular CNO/SAPHO. While heterogeneity among the studies precluded the extraction of statistically relevant information, BPNs are an effective treatment for mandibular CNO with minimal chance of jaw osteonecrosis and disturbance to the growing skeleton.