Osteonecrosis of the Jaw in Cancer After Treatment With Bisphosphonates: Incidence and Risk Factors

Abstract

The use of bisphosphonates seems to be associated with the development of ONJ. Length of exposure seems to be the most important risk factor for this complication. The type of bisphosphonate may play a role and previous dental procedures may be a precipitating factor.

Osteonecrosis of the jaw and use of bisphosphonates in adjuvant breast cancer treatment: a metanalysis

“…Indeed data from pooled-randomized evidences indicated that it occurred in only 13 of the 5,312 patients receiving bisphosphonates (0.24%). The observed incidence of the phenomenon was up to 20 times lower than those observed in patient treated for metastatic disease or multiple myeloma [18]. This could be explained by the dose intensity of bisphosphonates regimens used in the treatment of primary breast cancer, that are remarkably lower than those used in metastatic disease.…”

“…Anyhow, osteonecrosis of the jaw is an uncommon but serious side effect of bisphosphonates use and its incidence vary with length of exposure, being 5% among patients treated for 4-12 months, and rising to 7.7% after treatment for 37-48 months [18]. Therefore, considering the long life expectancy of patient with primary breast cancer, jaw osteonecrosis complication may jeopardize the quality of life of these patients for all their life.…”

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

“…BRONJ prevalence in cancer patients (range 3-18%) has been the focus of the majority of papers [3,55] to date, whereas the impact of BRONJ in non-cancer patients, with osteoporosis or Paget disease, who receive lower doses of BPs is less known [34,37]. The estimated prevalence of BRONJ in non-cancer (mainly osteoporotic) patients may range from 0.02% to 11% [22][23][24]29,33,36,42,44,47,49].…”

Long-term safety of monthly zoledronic acid therapy beyond 1 year in patients with advanced cancer involving bone (LoTESS): A multicentre prospective phase 4 study

“…Consequently, most treatment guidelines recommend the use of ZOL for at least 1 year with continuation at the physician's discretion (Hillner et al., 2003; Kyle et al., 2007; Lacy et al., 2006; van Poznak et al., 2011). In addition, increases in the incidence of osteonecrosis of the jaw (ONJ) and renal impairment were reported in patients receiving ZOL for time periods longer than 2 years (Bamias et al., 2005; Oh et al., 2007). These concerns prompted some oncologists to cease ZOL therapy after 1 or 2 years, despite the possible benefits in reducing SREs with longer therapy (Lacy et al., 2006).…”