Clinical experiences with bisphosphonate-associated osteonecrosis of the jaws: analysis of 21 cases

Am J Otolaryngol. 2009 Nov-Dec;30(6):390-5. doi: 10.1016/j.amjoto.2008.07.014. Epub 2009 Mar 9.

Abstract

Purpose: The aim of the present study was to analyze the clinical presentation, risk factors, radiologic features, histopathologic and microbiological findings, treatment, and evolution of bisphosphonate-associated osteonecrosis of the jaws (BONJ).

Methods: This study made a retrospective review of 21 patients who underwent treatment and diagnosis of BONJ during 2004 to 2007 in a tertiary health care center reference for 1,100,000 inhabitants.

Results: The mean patient age at the time of presentation was 65.1 years. Of the 21 patients observed, 19 (90.4%) were receiving intravenous zoledronate. Of the 21 patients, 15 were treated with bisphosphonates for bone metastasis (71.4%), 5 for multiple myeloma (23.8%), and 1 for rheumatoid arthritis (4.7%). In 17 patients, the lesions occurred in the mandible. Fifteen patients had previous tooth extractions at the same site of bone necrosis.

Conclusion: In our series, most patients improved with conservative surgical debridement. Prospective clinical trials would enable clinicians to make accurate judgments about risk, treatment, and outcome for patients with BONJ.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Bone Density Conservation Agents / adverse effects*
  • Bone Density Conservation Agents / therapeutic use
  • Bone Neoplasms / drug therapy
  • Bone Neoplasms / secondary
  • Breast Neoplasms / drug therapy
  • Breast Neoplasms / pathology
  • Debridement
  • Diphosphonates / adverse effects*
  • Diphosphonates / therapeutic use
  • Female
  • Humans
  • Imidazoles / adverse effects
  • Imidazoles / therapeutic use
  • Jaw Diseases / chemically induced*
  • Jaw Diseases / diagnostic imaging
  • Jaw Diseases / pathology
  • Male
  • Middle Aged
  • Multiple Myeloma / drug therapy
  • Multiple Myeloma / pathology
  • Osteonecrosis / chemically induced*
  • Osteonecrosis / diagnostic imaging
  • Osteonecrosis / pathology
  • Pamidronate
  • Prostatic Neoplasms / drug therapy
  • Prostatic Neoplasms / pathology
  • Radiography
  • Retrospective Studies
  • Risk Factors
  • Tooth Extraction / adverse effects
  • Treatment Outcome
  • Zoledronic Acid

Substances

  • Antineoplastic Agents
  • Bone Density Conservation Agents
  • Diphosphonates
  • Imidazoles
  • Zoledronic Acid
  • Pamidronate