DOI: 10.1093/bjs/znad258.005 ISSN:

891 A Systematic Review and Narrative Synthesis on the Efficacy of Bisphosphonate Therapy in the Management of Diffuse Sclerosing Osteomyelitis

S Nasri Elmi, S Van Der Lith, N Hawesa, M Abukhder
  • Surgery



Diffuse Sclerosing Osteomyelitis (DSO) of the mandible is a rare condition, characterised by recurrent severe pain, and functional disturbances such as trismus. Management of DSO through antibiotics, steroids, and analgesia has been generally unsatisfactory. Several articles have suggested the use of bisphosphonate therapy as an alternative treatment option to achieve long-lasting symptom improvement. We aim to summarise all evidence relating to the efficacy of bisphosphonate therapy in DSO.


A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies of six databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers.


Eight articles were eligible for inclusion. A total of 102 patients with a confirmed diagnosis of DSO received bisphosphonate treatment following a trial of conservative management. All studies reported significant reduction in levels of pain and swelling, and a reduction in cumulative doses of analgesics. Majority of patients reported that bisphosphonate therapy provided long-lasting symptom improvement. Three studies reported improvements in maximal mouth opening, with one study reporting a mean increase of 9.6mm. Improvements in panoramic radiographs and cone beam CT scans were also observed in five studies, with four patients demonstrating almost normal-to-normal bone architecture. Finally, all studies reported no long-term complications.


Bisphosphonate therapy does appear to be a promising treatment option for DSO. It has shown to improve symptoms and radiological features, providing long-term benefits. Further prospective studies are required to finetune treatment protocols.

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