Bisphosphonate osteonecrosis of the jaws; an increasing problem for the dental practitioner

McLeod, Niall; Davies, Ben; Brennan, Peter A.

doi:10.1038/bdj.2007.1065

Cited by 33 publications

(28 citation statements)

References 22 publications

(23 reference statements)

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“…bisphosphonates, it has been reported to be between 1-12%. 3,12,13 The results of this study (9.7%) fall within the reported range. Risk factors for BRONJ include: recent dento-alveolar surgery, 2,14,15 bisphosphonate exposure and frequency of administration, 16,17 potency of the drug, 16,18 local anatomy (mandible more common than maxilla and more common in areas with thin oral mucosa like tori and mylohyoid ridge), 12 oral disease, systemic conditions and co-morbidities, 12,18 and finally genetic factors.…”

Section: Discussionsupporting

confidence: 85%

Osteonecrosis of jaws related to intravenous bisphosphonates: the experience of a Jordanian teaching hospital

Baqain

Tamimi

Bsoul

et al. 2010

annals

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Ann R Coll Surg Engl 2010; 92: 489-494 489Bisphosphonate-related osteonecrosis of the jaws (BRONJ), first described by Marx, 1 is defined as jaw necrosis occurring either spontaneously or, more commonly, after simple dento-alveolar surgery in patients on bisphosphonates, commonly with the intravenous (i.v.) form of the drug. Bisphosphonates are non-metabolised analogues of pyrophosphate that localise to bone inhibiting the dissolution of hydroxyapatite crystals preventing bone resorption.2,3 Other effects include reducing blood flow and antiangiogenic properties, 4 contributing to the ischaemic changes noted in the affected jawbones. Bisphosphonates are preferentially deposited in bones with high turn-over rates, since the maxilla and mandible are sites of significant remodelling, it is possible that the levels of the drug within the jaw are selectively elevated.2 BRONJ is a multifactorial event with multicellular impairments, resulting in altered wound healing. 5Cancer patients with metastatic or primary bone lesions often develop sequential skeletal complications and hypercalcaemia of malignancy.6 Intravenous bisphosphonates are primarily used in the management of cancer-related hypercalcaemia and skeletal-related events associated with bone metastases including pain, pathological fracture, spinal cord compression, mostly with solid tumours such as breast, prostate and lung cancers.6 They are also effective in the management of lytic lesions in the setting of multiple myeloma; 7 multiple myeloma patients appear to have a uniquely elevated risk for the development of the condition as the disease itself is present in bone. 8 The most prevalent and common indication for oral bisphosphonates is osteoporosis. RESULTS Of the 41 patients, four developed BRONJ, two in maxilla, one in mandible and one bimaxillary. Patients with BRONJ were older; mean age was 69.3 ± 3.1 years compared to 62.8 ± 12.5 years (P = 0.022). Dental co-morbidities were more commonly present in patients with the disease (P = 0.038). Patients who developed BRONJ were on treatment for a longer duration of time; the mean duration of treatment was 23.5 ± 8.4 months compared to 11.9 ± 13.4 months (P = 0.10). CONCLUSIONS The results of this case series demonstrated that age and poor oral health status are significant risk factors of BRONJ for oncology patients on long-term frequent dosing schedule of i.v. bisphosphonates.

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Section: Discussionsupporting

confidence: 85%

Osteonecrosis of jaws related to intravenous bisphosphonates: the experience of a Jordanian teaching hospital

Baqain

Tamimi

Bsoul

et al. 2010

annals

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“…A thoughtful practitioner must reflect on the risks that the patient may be exposed to during oral surgery procedures, keeping up to date with evidence of emerging risks such as bisphosphonate therapy 5 and a variety of new drugs, particularly anticoagulants. The British National Formulary (BNF) and other useful resources 6 ought to be easily accessible in order to review the effects and side effects of any prescribed medication and any health impact of the proposed treatment.…”

Section: Relevant Medical Historymentioning

confidence: 99%

Risk management in clinical practice. Part 11. Oral surgery

Henderson¹

2011

Br Dent J

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“…These are usually taken weekly Intravenously administered bisphosphonates are; pamidronate and zoledronic acid. These are usually administered monthly On the other hand ibandronate and clodronate can be administered as orally and intravenously (7,8,9).…”

Section: Classificationmentioning

confidence: 99%