Bisphosphonate-induced osteonecrosis of the jaw (ONJ): Incidence and risk factors in patients with breast cancer and gynecological malignancies

Fehm, Tanja; Beck, V.; Banys, Malgorzata; Lipp, Hans‐Peter; Hairass, M.; Reinert, Siegmar; Solomayer, Erich; Wallwiener, D.; Krimmel, Michael

doi:10.1016/j.ygyno.2008.11.029

Cited by 100 publications

(100 citation statements)

References 28 publications

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“…ONJ is typically associated with intravenous bisphosphonate use. Among patients receiving bisphosphonates (without anti-angiogenic therapy), the reported incidence of ONJ ranges from 1 to 6% [7,8,[10][11][12][13][14][15]. An additional trigger factor, such as previous tooth extraction, surgical dental procedures or Actinomyces infection, is often reported in patients developing ONJ [7,12,16].…”

Section: Introductionmentioning

confidence: 99%

Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer

Guarneri

Miles

Robert³

et al. 2010

Breast Cancer Res Treat

242

150

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Long-term bisphosphonate therapy is associated with increased risk of osteonecrosis of the jaw (ONJ). In a retrospective analysis, a 16% ONJ incidence was reported in patients receiving bisphosphonates with antiangiogenic therapy (bevacizumab or sunitinib) for bone metastases from breast, colon, or renal cell cancers. To assess ONJ incidence with bevacizumab, we analysed data from 3,560 patients receiving bevacizumab-containing therapy for locally recurrent or metastatic breast cancer (LR/MBC) in two double-blind, randomised trials (AVADO and RIBBON-1) and a large, non-randomised safety study (ATHENA). The overall incidence of ONJ with bevacizumab was 0.3% in the blinded phase of the two randomised trials and 0

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Section: Introductionmentioning

confidence: 99%

Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer

Guarneri

Miles

Robert³

et al. 2010

Breast Cancer Res Treat

242

150

View full text Add to dashboard Cite

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“…In question number six we see a high percentage of clinicians that do not ask about a possible treatment with BP while doing the patient medical history, and in question number seven a large percentage do not know if they performed surgical dental treatments to patients who are / were treated with BP.A fairly large number, 34 respondent clinicians, do not know under what conditions they can perform tooth extractions or other dental surgical treatments in patients treated with BP.Studies have shown that dentoalveolarsurgery is considered a major risk factor, namely tooth extraction which acts as a trigger point in the development of BRONJ (27)(28)(29). Besides dental extractions, other dentoalveolar surgical procedures were incriminated, such as periapical and periodontal surgical procedures and implant insertion (30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

Bisphosphonate-Related Osteonecrosis of the Jaws: a real Challenge for Dentists

Ioana-Auriţa

Petrovan

Cuc

et al. 2015

Acta Medica Marisiensis

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Background: Osteonecrosis of the jaw is a serious complication associated with oral and intravenous bisphosphonate therapy. Its pathogenesis is not well understood and its management is difficult.The aim of ourstudy was to evaluate the awareness of dentists in Târgu Mureș on the possibilities of treating patients who are treated with bisphosphonate in dental offices. Material and method: We carried out a questionnaire-based study among dentists in Târgu Mureș reaching important issues such as: if the patient is asked if medical history follows / followed treatment with bisphosphonates, if they made surgical treatment in these patients, if they know under what conditions can they perform this treatment, if they deem it is necessary to contact the prescriber before surgical treatment. Results: Seventy questionnaires were returned. During the medical history most clinicians (60%) asked the patients whether they follow/followed treatment with bisphosphonates and most of them (42.85%) did not perform treatments in these patients. While 85.71% of respondents declared that they do contact the prescriber before performing surgical treatment, 48,57% were not aware under what conditions they could undergone the treatment. Conclusions: The dentists did not seem to be well informed about this pathological entity, known only since 2003. In the absence of appropriate protocols they could not provide a high quality treatment and in these circumstances they might do more harm than good.

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“…The estimated cumulative hazard rate of developing ONJ has been reported to be 1% at 1 year and 21% at 3 years or 15% at 4 years [30,38] with zoledronate and 7% at 3 years with pamidronate [30]. In cases of oral use, patients in some studies received biphosphonate for a mean duration of 24-40 months before the occurrence of ONJ [12, Etidronate (1 [10,[14][15][16][17][18][19][20][21]; no case has been found with tiludronate. The clinical presentation of alkylbiphosphonate-induced ONJ is very similar to that of aminobiphosphonate-induced ONJ.…”

Section: Discussionmentioning

confidence: 99%

“…Twentyseven cases were identified: 25 with clodronate and two with etidronate [10,[14][15][16][17][18][19][20][21]. Among these 27 cases, clodronate was used alone in eight cases and etidronate alone in two cases.…”

Section: Case Reports Of Alkylbiphosphonate-induced Onjmentioning

confidence: 99%

“…Risk factors such as administration route, indication, duration of treatment and administrated cumulative dose of biphosphonates have already been described. Several other factors also seem to favour ONJ occurrence, including dental risk factors (tooth extraction, periodontal disease, other surgical or invasive dental procedure), which were present in nearly 70% of reported cases, cancer and anti-cancer therapy (local radiotherapy, chemotherapy etc), corticosteroids and various comorbidities (diabetes, anaemia, among others) [9][10][11][12]. Only a few cases have been reported with alkylbiphosphonates.…”

Section: Introductionmentioning

confidence: 99%

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Osteonecrosis of the jaw induced by clodronate, an alkylbiphosphonate: case report and literature review

Crépin

Laroche

et al. 2010

Eur J Clin Pharmacol

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Purpose To report on a case of osteonecrosis of the jaw (ONJ) in a patient treated with clodronate, an alkylbiphosphonate, and to draw attention to the risk of ONJ following treatment with all biphosphonates, whether they are alkyl-or amino-biphosphonates. Case report Beginning at age 58 years, a female patient took clodronate for almost 13 years for a metastatic bone cancer. She also underwent chemotherapy and radiotherapy. Three months after the end of biphosphonate therapy, she suffered from toothache, and tooth 27 (left maxillary second molar) was extracted. A maxillary focus of osteitis with an oral sinus communication was discovered, and a maxillofacial denture prosthesis was grafted in September 2006. Some days later, the patient consulted her dentist for an ulceration of the oral cavity floor in front of tooth 33 (left mandibular canine) extending to the left inferior side of the lip. In October 2006, teeth 33 and 34 (left mandibular first premolar) were extracted. No secondary infection occurred. A complete healing was only observed 3 months after the last extraction. ONJ due to alkylbiphosphonate treatment was diagnosed as bone reconstruction and mucous cicatrisation were delayed. Methods A systematic review was carried out to identify all cases of alkylbiphosphonate-induced ONJ by searching the Medline and Cochrane databases using 'osteonecrosis of the jaw', 'jaw diseases', 'osteonecrosis', 'diphosphonate', 'biphosphonate' (amino-, alkyl-or the international nonproprietary name) as the main search items. The search was limited to English-and French-language articles published between 1966 and February 2010. Results Our search identified 27 cases of alkylbiphosphonateinduced ONJ in the literature. Among these cases, only ten patients were on alkylbiphosphonate monotherapy; in the other cases, aminobiphosphonates had also been used. The clinical presentation of the alkylbiphosphonate-induced ONJ was similar to that most often encountered with aminobiphosphonate treatment. The duration of exposure before onset was higher with alkylbiphosphonates than with aminobiphosphonates, and dental procedures before ONJ were frequent. Conclusion Osteonecrosis of the jaw has been widely reported with various aminobiphosphonates, but data on the role of alkylbiphosphonates are scarce. As these latter drugs are less potent, a high cumulative dose through long-term exposure would appear to be necessary and would favour ONJ. Although the degree of risk for ONJ occurrence in patients on alkylbiphosphonates remains uncertain, it would be wise to reconsider carefully the indications for using these agents and to apply preventive measures as is currently done for aminobiphosphonates.

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Bisphosphonate-induced osteonecrosis of the jaw (ONJ): Incidence and risk factors in patients with breast cancer and gynecological malignancies

Cited by 100 publications

References 28 publications

Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer

Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer

Bisphosphonate-Related Osteonecrosis of the Jaws: a real Challenge for Dentists

Osteonecrosis of the jaw induced by clodronate, an alkylbiphosphonate: case report and literature review

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