Pharmacogenetics of bisphosphonate-associated osteonecrosis of the jaw

Front Biosci (Elite Ed). 2011 Jan 1;3:364-70. doi: 10.2741/e251.


An undesirable effect associated with bisphosphonates is osteonecrosis of the jaw (ONJ). Case reports discussed ONJ development in patients with multiple myeloma or metastatic cancers receiving bisphosphonates as palliation for malignant bone disease. No causative relationship has been unequivocally demonstrated between ONJ and bisphosphonate therapy. To determine if a higher sensitivity to bisphosphonates could in part explain the development of ONJ, the segregation of A/C rs2297480 polymorphism of gene encoding for the farnesyl pyrophosphate synthase (FDPS) with ONJ was evaluated in a cohort of 68 Caucasian patients treated with zoledronic acid for multiple myeloma and metastatic mammary and prostate cancer. The AA and CC genotypes were highly differently distributed among ONJ patients and controls, matched for sex and type of malignant disease, with a positive correlation between AA carrier status and occurrence of ONJ (p=0.03) after 18-24 months of treatment. Because FDPS gene variants have been associated with bone morbidity, these pharmacogenetic association likely reflect the interaction of amino-bisphosphonates with germline sensitivity to drug actions, and might identify patients at highest risk to develop ONJ.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone Density Conservation Agents / pharmacology
  • Diphosphonates / adverse effects*
  • Diphosphonates / pharmacology
  • Diphosphonates / therapeutic use
  • European Continental Ancestry Group / genetics
  • Female
  • Gene Frequency
  • Genetic Predisposition to Disease / genetics*
  • Geranyltranstransferase / genetics*
  • Humans
  • Imidazoles / pharmacology
  • Italy
  • Jaw Diseases / chemically induced*
  • Male
  • Multiple Myeloma / drug therapy*
  • Osteonecrosis / chemically induced*
  • Pharmacogenetics
  • Polymorphism, Single Nucleotide / genetics
  • Retrospective Studies
  • Zoledronic Acid


  • Bone Density Conservation Agents
  • Diphosphonates
  • Imidazoles
  • Zoledronic Acid
  • Geranyltranstransferase