Osteonecrosis of the Jaw After Bisphosphonates Treatment in Patients with Multiple Myeloma

Abstract

Background:Bone lytic lesion in Multiple myeloma are the most commonly presented symptoms which require treatment with bisphosphonates (BPs). BPs are providing supportive care, reducing the rate of skeletal morbidity but evidently not abolishing it, the criteria for stopping their administration have to be different from those used for classic antineoplastic drugs, and they should not be stopped when metastatic bone disease is progressing. Osteonecrosis of the jaw (ONJ) has been associated recently with the use of BPs.Aim:The aim of these study is to evaluate the incidence of ONJ in patients with MM treated with mixed biphosphonates.Patients and methods:We analyzed total 296 myeloma patients (150 male and 146 female). Mostly effected age group with 58,1% is age more than 60 years up to 88 years, diagnosed in our institution in the period 2005-2015. We used intravenous or oral forms of biphosphonates such as pamidronate, ibandronate, clodronate and zolendronic acid. The patients were evaluated for ONJ.Results:The incidence of ONJ in our group of patients treated with Bps was 4,6% from our group of 260 patients 87,8% received BPs therapy and patients which haven’t received BPs 12,2%. From this group, 95,4% (248) didn’t show ONJ, and 4,6% (12) showed ONJ. The period of this treatment with BPs is an important risk factor for development of ONJ, average duration of BPs therapy in patients which show adverse effects is 26.8±13.7 months, from the total number of 12 patients that developed ONJ adverse effects, we have 8 patients which received treatment with Zolendronic acid and the remaining 4 patients which were treated with other BPs combinations without Zolendronic acid.Conclusions:All patients treated for MM must continue with the therapy with Zolendronic acid and Pamidronate, each patient must be individually treated according to his response of the treatment (dose, frequency and duration of therapy).

Histone deacetylases (HDAC) in physiological and pathological bone remodelling

“…Current treatment for MM bone disease involves the use of bisphosphonates that are effective at inhibiting osteoclast activity. Bisphosphonates have however been shown to be associated with osteonecrosis of the jaw, but this is dependent upon a number of factors including route of administration, use with other agents and time of exposure to BPs [106].…”

Review and update on drugs related to the development of osteonecrosis of the jaw

“…Pamidronate and zoledronate have a potency that is between 100 to 1000 times higher than the non-nitrogenated bisphosphonates and are administered intravenously, primarily in cancer patients. These are the ones at greatest risk and incidence data have been published with a variation between 0.7% and 6.7% of patients (21,33,34). In smaller prospective studies, as far as the number of patients is concerned, prevalence figures of over 23% have been published (35).…”

Radiographic bone loss and the risk of medication‐related osteonecrosis of the jaw (MRONJ) in multiple myeloma patients—A retrospective case control study

“…Multiple myeloma (MM) is hematological cancer that accounts for 1% of all cancer and 10% of all hematological malignancies . Bone disease may affect up to 70% of these patients .…”