Osteomylelitis and necrosis of the jaw in patients treated with bisphosphonates: a comparative study focused on multiple myeloma

Abstract

It was reported that multiple myeloma (MM)-patients suffer from a higher incidence of osteomyelitis and necrosis of the jaws than patients treated with bisphosphonates for other reasons. The aim of this study is to report about 57 cases of bisphosphonate-related osteomyelitis and necrosis of the jaws (BON) and to investigate the differences between BON in MM and non-MM patients. Clinical and laboratory data of 57 cases were assessed. The features of BON and clinical-outcome were compared between the two groups. Treatment approach was assessed as a contributing-factor to treatment-outcome. Clinical presentation included exposed bone, pain, swelling and suppuration with little variation between the two groups. Past dento-alveolar surgery was common in both study-groups. Treatment outcome was poor (33% and 25% responded to treatment in MM group and non-MM group, respectively). Treatment modality did not affect the treatment outcome. The clinical presentation described in this case series should alert the physician to the possibility of BON. Although the literature shows a higher incidence of BON in MM patients compared to non-MM patients, our study suggests that the severity of the clinical presentation and the response to treatment are not worse in MM patients compared with non-MM patients. The predisposition of MM patients to BON should be further investigated.

Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review

“…Two hundred papers were included in the qualitative synthesis and finally 103 papers were excluded after a preliminary review, due to non-compliance with the inclusion/exclusion criteria, lack of outcome, not being related to the proposed research question, or being irrelevant (Fig. 1 [151][152][153][154] (Table 2).…”

“…17,27,44,49,68,69,72,73,76,78,89,90,94,[100][101][102][104][105][106][107]110,113,[116][117][118]123,[125][126][127][128][129][130][131][132][133][134][135][136]139,141,144,150,152,154 Major surgical intervention was reported in 22 publications, 17,44,68,92,100,103,106,115,…”

Osteonecrosis of the Jaw Correlated to Bisphosphonate Therapy in Non-oncologic Patients: Clinicopathological Features of 24 Patients

“…The Journal of on July 24, 2015 -Published by www.jrheum.org Downloaded from oxygen administration 12,[31][32][33] . Although surgery was found to be nonbeneficial for neoplastic patients with ONJ taking intravenous bisphosphonates, it is accepted 31,32 that surgical procedures may achieve better outcomes in non-neoplastic patients.…”

Oral Bisphosphonate-Related Osteonecrosis of the Jaw: Incidence, Clinical Features, Prevention, and Treatment Recommendations

“…This includes tooth extraction, dental implants, and periodontal surgery. BRONJ has reportedly developed spontaneously in 14-50% [4,9,14,30]. Most of the available data on triggering events concern oncologic patients, while similar data on patients with osteoporosis are limited.…”