Oral bisphosphonate-related osteonecrosis of the jaws: Clinical characteristics of a series of 20 cases in Spain

Abstract

Objective: The objective of this study was to define the clinical characteristics of osteonecrosis of the jaws (ONJ) induced by oral bisphosphonates in a series of patients from a circumscribed area in northwest Spain. Study Design:A retrospective multicentre study was undertaken in 3 hospitals in an area with a radius less than 100 km in the Autonomous Community of Galicia (Spain). The medical records were reviewed and an oral examination was performed of patients diagnosed with oral bisphosphonate-related ONJ in the previous 3 years. Results: We detected 20 cases of ONJ (24 lesions) related to oral bisphosphonates (alendronate [16 patients] and ibandronate [4 patients]), which were mainly administered as treatment for osteoporosis (17 patients). The mean interval between initiation of treatment and confirmation of a diagnosis of ONJ was 66±43 months (range, 6-132 months); in 7 patients (35%) the interval was less than 36 months. The past history revealed hypertension in 13 cases (65%) and diabetes in 4 (20%); 7 patients (35%) were on corticosteroid treatment. Oral surgery had been previously performed in 13 patients (65%) and the remaining 7 patients (35%) had removable dental prostheses. The lesions most frequently affected the posterior mandible (62.5%). The majority of the lesions (75%) were classified as stage 2, although lesions were identified in all established clinical stages (including 2 stage 0 lesions). Conclusion: In conclusion, in the present series, ONJ induced by oral bisphosphonates typically develops in women around 70 years of age, taking alendronate, that underwent oral surgery. Most lesions are located in the posterior mandible and are classified as stage 2 at diagnosis. Some patients presented no known risk factors, suggesting that there may be risk factors still to be identified. There are well-defined patterns of clinical presentation that can facilitate early diagnosis of ONJ. Key words:Oral bisphosphonates, osteonecrosis of the jaws, alendronate.

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

“…Such a fact would indicate that the short time period of BP exposure may not always necessarily constitute a safety threshold relating to the risk of BRONJ in any given patient and, in every case, the tailoring of BP therapy to individual patients would be beneficial. The most frequent observation in our sample of the AAOMS stage 2 BRONJ (60.9%) correlates with the data reported in other studies [5,12,16,31]. It is our opinion that this frequent datum is relevant to explaining the incidence of a tardy BRONJ diagnosis, either due to delay, a misdiagnosis or a low level of awareness by the physician.…”

“…Concurring with other authors [11][12][13]32,41], we observed and described 87 cases of BRONJ in patients taking oral BPs; these cases have been described and correlated with other cases [5,12,16,31], mainly occurring in the mandible (73.6%). One limitation of our research was the non-controlled study design which may have led to an overestimation of BRONJ in non cancer-patients.…”

“…Even if the longer-term use of oral BPs should have a dose equivalence effect [48], it is notable that the mean time of presentation was approximately 3 yrs (38 months) in the patients in this study, as already described in the literature [12,16,35]. Such a fact would indicate that the short time period of BP exposure may not always necessarily constitute a safety threshold relating to the risk of BRONJ in any given patient and, in every case, the tailoring of BP therapy to individual patients would be beneficial.…”

“…Other authors [12] have recently described a total of 310 patients with BRONJ from oral BP, after a Pub-Med-based search of case series with a minimum number of 10 subjects. Reid and Cornish [42] have reported 261 cases of BRONJ in patients who had received oral BP, the majority of whom were treated by the most widely used amino-BP (NBP), that is, alendronate.…”

Multifocal osteonecrosis and osteomyelitis in a liver transplant recipient

“…[4] On the other hand, prolonged therapy with bisphosphonates, adversely leads to ON of the jaws in some patients. [14] Bisphosphonates associated ON rarely occurs in the long bones, only one case was reported on zoledronic acid therapy. [15] In a study, 20 cases of bisphosphonate-related osteonecrosis were reviewed and 16 alendronate and four ibandronate usage were reported.…”