Bisphosphonate-associated osteonecrosis of the jaws: Case reports and analysis of 184 cases

Abstract

18595 Background: In this study, we described four new cases of bisphosphonates-related jaw osteonecrosis and reviewed the English Medical Literature for similar case reports. Methods: A MEDLINE literature search was performed from September 2003 to November 2005 for all case reports of bisphosphonates-associated jaw osteonecrosis. Results: Our patients were three female and one male with a median age of 50.5 years (range, 35–57 years). Two patients had breast cancer and two another had multiple myeloma. Two patients received pamidronate initially and were switched later to zoledronate. The two other patients were treated with zoledronate. The median duration from the first administration of bisphosphonates to the diagnosis of osteonecrosis was 48 (range, 18–75) months. Review of the literature of all published cases revealed 184 patients. Age of these patients ranged from 37 to 89 years (median, 64 years). Seventy-eight patients (43.4%) were treated with bisphosphonates for metastatic breast carcinoma, 65 (36.3%) for multiple myeloma, and 14 (7.8%) for metastatic prostate cancer. Thirteen patients (7.2%) without cancer diagnosis were treated for osteoporosis (10 patients) or Paget’s disease (3 patients). Primary disease was not specified in five patients. Eighty-two patients (46.8%) were treated with pamidronate, 47 (26.8%) treated with zoledronate, 35 (20%) treated with pamidronate initially and later were changed to zoledronate, 9 (5.1%) treated with oral bisphosphonates and 2 (1.1%) treated with oral bisphosphonates initially and subsequently switched to zoledronate. Type of bisphosphonate was not specified in ten patients. The duration of bisphosphonates treatment was available for 45 patients (24.4%) and ranged from 1 to 93 (median, 28) months. Conclusion: Oncologists and dental professionals should be aware of this potential serious complication of long-term bisphosphonates treatment and special caution should be taken before dental intervention in such patients. No significant financial relationships to disclose.

Optimizing Clinical Benefits of Bisphosphonates in Cancer Patients with Bone Metastases

“…However, acute-phase reactions are usually self-limited and manageable with nonsteroidal anti-inflammatory agents or acetaminophen [81]. Recently, exposed bone in the jaw-ONJ-has been reported as an uncommon event among patients with cancer whose treatment includes a monthly intravenous bisphosphonate [81][82][83][84][85][86][87][88]. Furthermore, ONJ has been reported in a very small number of patients who were receiving oral bisphosphonates for noncancer indications [82,86,87].…”