Bisphosphonate-Related Osteonecrosis of the Jaws: A Single-Center Study of 101 Patients

doi:10.1016/j.joms.2008.11.015

Journal of Oral and Maxillofacial Surgery

Volume 67, Issue 4, April 2009, Pages 850-855

https://doi.org/10.1016/j.joms.2008.11.015 Get rights and content

Purpose

Osteonecrosis of the jaw (ONJ) is a devastating side effect of long-term bisphosphonate (BP) use. We present the largest case series from a single department.

Materials and Methods

This case series included 101 ONJ patients. Data on demographics, medical background, type and duration of BP use, possible triggering events, mode of therapy, and outcome were recorded.

Results

ONJ was associated with intravenous BPs in 85 patients and with oral BPs in 16 patients. It was diagnosed after 48, 27, and 67 months of pamidronate, zoledronic acid, and alendronate use, respectively. Long-term antibiotics and minimal surgical procedures resulted in complete or partial healing in 18% and 52% of the patients, respectively; 30% had no response. There was no association between ONJ and diabetes, steroid and antiangiogenic treatment, or underlying periodontal disease. Diagnostic biopsies aggravated lesions without being informative about pathogenesis. A conservative regimen is our treatment of choice.

Conclusion

Solutions for decreasing morbidity and poor outcome of ONJ remain elusive.

Section snippets

Patients

The study included all patients with ONJ after treatment with BPs who were followed up at the Department of Oral and Maxillofacial Surgery, Sheba Medical Center (Tel Hashomer, Israel) between April 2003 and January 2008 and examined by 2 members of the department (N.Y. and T.S.L.). Criteria for inclusion in the study, in accordance with the American Association of Oral and Maxillofacial Surgeons' position paper on BP-related ONJ, were as follows: history of BP therapy, intraoral lesions (eg,

Patients

The study group included 66 women (mean age, 63 years; range, 40-85 years) and 35 men (mean age, 64 years; range, 54-88 years) diagnosed as having BP-associated ONJ.

Smoking Habits

Of the patients, 19 (19%) had a history of smoking either currently or in the recent past. The mean smoking consumption was 21 cigarettes per day (range, 7-35 cigarettes per day), and the mean duration of cigarette smoking was 29 years (range, 20-40 years).

BP Indication

Of the patients, 43 (43%) received IV BPs (pamidronate or zoledronic acid)

Discussion

During the past decade, BPs have been widely used for the treatment of bone metastases in malignancies, such as multiple myeloma and breast and prostate carcinoma,1, 2, 3, 4, 5, 6, 7 as well as for bone resorption diseases, such as osteopenia and osteoporosis.⁸

With improvement in treatment protocols for cancer patients, increasing numbers of patients will be able to receive BPs for many years. This, together with the increase in life expectancy, will probably lead to more patients being

Acknowledgments

The authors thank Ms Esther Eshkol for editorial assistance.

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The standard treatment for medication-related osteonecrosis of the jaw (MRONJ) is surgery. However, reports on the appropriate extent of bone resection are few. We aimed to examine the relationship between the extent of bone resection and postoperative outcomes in patients with mandibular MRONJ.
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Basic and patient-oriented researchBisphosphonate-Related Osteonecrosis of the Jaws: A Single-Center Study of 101 Patients

Purpose

Materials and Methods

Results

Conclusion

Section snippets

Patients

Patients

Smoking Habits

BP Indication

Discussion

Acknowledgments

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Am Dent Assoc

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Craniomaxillofac Surg

Med Hypotheses

J Oral Maxillofac Surg

Overview of bisphosphonates

Cancer

A dose-finding study of zoledronate in hypercalcemic cancer patients

J Bone Miner Res

Bisphosphonates inhibit breast and prostate carcinoma cell invasion, an early event in the formation of bone metastases

Cancer Res

Bisphosphonate therapy in multiple myeloma: Past, present, future

Eur J Haematol

Intravenous pamidronate disodium treatment of bone metastases in patients with breast cancerA dose-seeking study

Cancer

Basic and patient-oriented research
Bisphosphonate-Related Osteonecrosis of the Jaws: A Single-Center Study of 101 Patients