Bridging the gap between osteoporosis and osteonecrosis of the jaw: preventing and treating BRONJ with MK4

Compend Contin Educ Dent. 2011 Oct;32(8):e125-31.


Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an iatrogenic disease and a significant concern to patients and dentists. Bisphosphonates are used for millions of men and women with osteoporosis, with the rationale being that these medications increase bone mineral density and decrease fracture risk. Clinicians will undoubtedly encounter some patients who are taking bisphosphonate medications. Recognizing the risk factors for BRONJ, understanding the pathophysiology of BRONJ, and enacting a reasonable approach to prevent BRONJ in patients is crucial to providing safe and effective treatments. This article proposes a rational approach for moving BRONJ away from a risk management and quality assurance model that is currently being used by dentists, to a preventive model. The role of collagen as postulated in this article cannot be ignored in the pathophysiology and potential prevention and treatment of osteoporosis and BRONJ. Studies from the medical literature support the safety and efficacy of MK4 as a potential therapeutic agent in preventing and treating osteoporosis and BRONJ. While the approach outlined herein requires additional study, the conceptual framework based on a broad review of the osteonecrosis of the jaw (ONJ) literature provides a means to begin to address this situation in a proactive, rather than reactive, way.

Publication types

  • Review

MeSH terms

  • Bisphosphonate-Associated Osteonecrosis of the Jaw / drug therapy*
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / etiology
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / physiopathology
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / prevention & control
  • Collagen / physiology*
  • Diphosphonates / adverse effects*
  • Humans
  • Osteoporosis / drug therapy*
  • Vitamin K 2 / analogs & derivatives*
  • Vitamin K 2 / pharmacology


  • Diphosphonates
  • Vitamin K 2
  • menatetrenone
  • Collagen