Bisphosphonate-associated osteonecrosis of the jaw: a review of 35 cases and an evaluation of its frequency in multiple myeloma patients

Abstract

Over a period of 28 months, we observed five cases of osteonecrosis of the jaw (ONJ) in cancer patients treated with bisphosphonates (BP) at our institution. This prompted us to undertake a retrospective, multicenter study to analyse the characteristics of patients who exhibited ONJ and to define the frequency of ONJ in multiple myeloma (MM). We identified 35 cases in Gruppo Italiano Studio Linfomi centers during the period 2002 - 05. The median time from cancer diagnosis to the clinical onset of ONJ was 70 months. In these 35 cases of ONJ, 24 appeared 20 - 60 months after starting BP treatment. The time for the onset of ONJ was significantly shorter for patients treated with zoledronic acid alone than for those treated with pamidronate followed by zoledronic acid. The frequency of ONJ in the MM group during the study period was 1.9%, although the nature of the present study may have resulted in an underestimation of ONJ cases. Our analysis strongly suggested an association between the use of BP and the occurrence of ONJ, although we were unable to identify any definite risk factors with a retrospective study. The most frequently ONJ-associated clinical characteristics were chemotherapy treatment, steroid treatment, advanced age, female sex, anemia, parodonthopaties/dental procedures and thalidomide (in the case of MM patients).

A multicenter, randomized clinical trial comparing zoledronic acid versus observation in patients with asymptomatic myeloma

“…33 The patients with the greatest risk of developing ONJ seem to be those with MM who have received zoledronic acid for more than 24 months. [47][48][49] By using adequate prophylactic measures, such as a careful baseline dental assessment, oral hygiene, and no invasive local procedures during the treatment with BP, the risk of ONJ decreases significantly. 50,51 However, in 2004, this information was not available, and the exact relation between zoledronic acid and ONJ was not clearly established.…”

Allogeneic mesenchymal stem cells and xenogenic platelet rich plasma, associated or not, in the repair of bone failures in rabbits with secondary osteoporosis

“…However, adverse effects such as gastrointestinal intolerance 7 , esophageal erosions, fever, atrial fibrillation, scleritis and mandibular osteonecrosis 7 have been described, limiting its wide use 8 .…”

Efeito do extrato de Ginkgo biloba L., Ginkgoaceae, na osteoporose induzida em ratas Wistar

“…Os resultados do presente trabalho, embora preliminares com o EGb são promissores, uma vez que o alendronato de sódio mesmo tendo sua eficiência comprovada no tratamento da osteoporose, possui alguns efeitos colaterais importantes como a osteonecrose mandibular (Pozzi et al, 2007), o que restringe sua prescrição, principalmente em pacientes que serão submetidos a cirurgias odontológicas.…”

“…Os bifosfonatos são drogas muito eficientes no tratamento da osteoporose, porém alguns efeitos adversos destes medicamentos têm sido relatados, tais como: intolerância gastrointestinal (Szejnfeld, 2000) e oteonecrose mandibular (Pozzi et al, 2007). Dessa forma é interessante a busca por alternativas ao tratamento da osteoporose.…”