Bisphosphonate Complications Including Osteonecrosis of the Jaw

Abstract

Bisphosphonate therapy has been incorporated in the standard management of patients with multiple myeloma-related bony disease. Although their efficacy in reducing skeletal related events is important in the supportive management of the myeloma patient, post-marketing experience with this class of agents, particularly the more potent intravenous agents pamidronate and zoledronic acid, have raised cautionary notes regarding the potential side effects of these agents. The focus of this session is to review the risk factors, incidence, prevention strategies and management of bisphosphonate-related osteonecrosis of the jaw. In addition, pathophysiology, incidence and monitoring for renal dysfunction during chronic therapy with these agents are reviewed.

Bisphosphonate-related osteonecrosis of the jaws: Report of two cases with breast cancer, a dental concern and review of the literature

“…It has been reported that oral BPs posed a lower risk since it took longer to develop bisphosphonate-induced osteonecrosis because of a slower accumulation rate in the bone [22]. Pamidronate is 10 times more potent than clodronate, while zoledronate is 10,000 times more potent in its osteoclastic inhibitory activity than the oral bisphosphonate [40]. However, there are many patients taking oral BPs for the treatment of osteoporosis, so it is very important to assess the risks, especially in patients taking BPs for a long period of time (longer than 3 years) [12].…”

Bisfosfonatlara Bağlı Olarak Çene Kemiklerinde Gelişen Osteonekroz (Bon) ve Güncel Tedavi Yöntemleri

“…Alkilbisfosfonat kullanan hastalarda BON gelişimi daha uzun kullanım sürelerinden sonra gelir. Bu ortalama süre klodronat için 35 ay, zoledronat için 9-18 ay, pamidronat için ise 14-24 ay olarak bildirilmiştir [32][33][34] . Diğer faktörler hazırlayıcı etkenler olup, belirgin linea mylohyoidea, torus ve ekzostoz tarzında anatomik yapılarla ilgili lokal risk faktörleri, kötü ağız hijyeni, periodontal hastalıklar, abse oluşumu, uyumsuz protezler, sağlıksız restorasyonlar, başarısız endodontik tedaviler, geniş kemik yüzeyleri açığa çıkaran cerrahi işlemler, yüksek seviyeli vazokonstiktör katkılı anestetik solüsyon kullanımları dental risk faktörleridir.…”

Dental complications and management of patients on bisphosphonate therapy: A review article

“…ONJ should be properly characterized and staging should be done so that appropriate treatment can be done (Table 2). 12 …”

“…It usually presents as area of exposed bone along with soft tissue swelling, purulent discharge, loosening of teeth and the lesion do not respond to local debridement and antibiotics. 12,13 Lesion develops around sharp bony area or previous surgical site including extraction, retrograde apicoectomies, periodontal surgery and dental implant surgery. There also may be feeling of numbness, heaviness or dyesthesia of jaw.…”