Imaging Findings of Bisphosphonate-Associated Osteonecrosis of the Jaws

Phal, Pramit M.; Myall, Robert W.T.; Assael, Lemon A.; Weissman, Jane L.

doi:10.3174/ajnr.a0518

Cited by 135 publications

(124 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nitrogencontaining bisphosphonates (intravenous zoledronic acid or pamidronate), together with other treatment options, are used widely for the treatment of these negative skeletal events [1]. In 2003, after an alert initial observation by Wang et al [2] at the University of California San Francisco, Rosenberg and Ruggiero [3], Marx [4] and Migliorati [5] have reported unusual findings of osteomyelitis-like lesions of the jaws in a set of patients affected by multiple myeloma and metastatic bone disease; subsequently, several papers have confirmed the initial observations and called this condition bisphosphonaterelated osteonecrosis of the jaws (BRONJ) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. All the initial observations have pointed to the potential role of the intravenously administered bisphosphonates such as pamidronate and zoledronate.…”

mentioning

confidence: 78%

“…Other radiographic findings include non-healing extraction site, widening of the periodontal ligament space and osteosclerotic lamina dura (Fig. 3) [10,[17][18][19]22]. In cases of extensive bone involvement, areas of mottled bone similar to that of diffuse osteomyelitis become evident (Fig.…”

Section: Clinical and Radiographic Featuresmentioning

confidence: 99%

“…The duration of bisphosphonate therapy is also an important factor which relates to the likelihood of developing BRONJ. In addition, the more potent nitrogen-containing bisphosphonates, such as pamidronate and zolendronate, are more often associated with the development of BRONJ than the oral bisphosphonate formulations [16][17][18][19][20][21][22][23][24][25]. An important paper published recently by Corso et al [44] has highlighted the importance of reducing the schedule of zolendronic acid in order to lower the risk of BRONJ in patients with multiple myeloma.…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Bisphosphonate-related Osteonecrosis of the Jaws: An Update on Clinical, Pathological and Management Aspects

Ficarra

Beninati

2007

Head and Neck Pathol

View full text Add to dashboard Cite

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is mainly observed in patients with multiple myeloma and bone metastasis from solid tumors receiving iv bisphosphonate therapy. The reported incidence of BRONJ is significantly higher with the iv preparations zoledronic acid and pamidronate while the risk appears to be minimal for patients receiving oral bisphosphonates. Currently available published incidence data for BRONJ are based on retrospective studies and estimates of cumulative incidence range from 0.8 to 12%. The mandible is more commonly affected than the maxilla (2:1 ratio), and

show abstract

mentioning

confidence: 78%

Section: Clinical and Radiographic Featuresmentioning

confidence: 99%

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Bisphosphonate-related Osteonecrosis of the Jaws: An Update on Clinical, Pathological and Management Aspects

Ficarra

Beninati

2007

Head and Neck Pathol

View full text Add to dashboard Cite

show abstract

“…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%

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

Crépin

Laroche

et al. 2010

Eur J Clin Pharmacol

View full text Add to dashboard Cite

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.

show abstract