Severe osteomyelitis of the jaw in long-term survivors of multiple myeloma: A new clinical entity

Lugassy, Gilles; Shaham, Rachel; Nemets, Anatoly; Ben-Dor, David; Nahlieli, Oded

doi:10.1016/j.amjmed.2004.04.015

Cited by 113 publications

(66 citation statements)

References 4 publications

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“…Since these initial reports, numerous case series have been reported in the literature (6). As previously mentioned the great majority of information regarding ONJ has been from case series (5)(6)(7)(8)(9)(10)(11). There are a limited number of retrospective studies available; the largest is a series of 4,000 cancer patients reported by Hoff et al This study, similar to other reports showed an association of ONJ with previous dental trauma (most commonly extraction).…”

Section: Discussionsupporting

confidence: 65%

“…Overwhelmingly, ONJ cases are seen in the oncologic population, where patients are often receiving concomitant chemotherapeutic agents and are consequently immunosuppressed. To date, our knowledge regarding ONJ has been derived from case report studies (6)(7)(8)(9)(10)(11). The largest and most comprehensive study by Hoff et al reported on 4,000 cancer patients where 33 developed ONJ.…”

Section: Introductionmentioning

confidence: 99%

“…Spontaneous cases occur in about 30 % of patients; however, such cases are typically localized to areas that are easily injured with very thin overlying mucosa, such as in the mylohyoid ridge region (5)(6)(7)(8)(9)(10)(11)(12). Several theories have been proposed regarding the pathoetiology of ONJ with most speculation focusing on origin from the bone.…”

Section: Introductionmentioning

confidence: 99%

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Inhibition of Oral Mucosal Cell Wound Healing by Bisphosphonates

Landesberg

Cozin

Cremers

et al. 2008

Journal of Oral and Maxillofacial Surgery

275

161

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Bisphosphonates are a widely used class of drugs that have been proven to be extremely useful in the prevention and treatment of osteoporosis, hypercalcemia of malignancy, and bone metastases associated with multiple myeloma, breast cancer, and other solid tumors. In the past several years there have been numerous reports describing the occurrence of Osteonecrosis of the Jaws (ONJ) associated with these drugs. In the great majority of cases this condition develops after surgical manipulation of the oral tissues. The natural history and pathophysiology of ONJ however, remains unknown at the present time. Furthermore, whether the ONJ lesion initiates in the oral mucosa or derives from the underlying bone has not been determined. In this report we describe the effect of pamidronate, a second generation bisphosphonate, on oral mucosal cells. Our results show that bisphosphonate pre-treatment of oral mucosal cells inhibits proliferation and wound healing at clinically relevant doses and that this inhibition is not due to cellular apoptosis.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Inhibition of Oral Mucosal Cell Wound Healing by Bisphosphonates

Landesberg

Cozin

Cremers

et al. 2008

Journal of Oral and Maxillofacial Surgery

275

161

View full text Add to dashboard Cite

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“…However, even for patients with multiple myeloma who are potential candidates for hematopoietic stem-cell transplantation or continued chemotherapy, asymptomatic osteonecrosis may not necessarily pose a substantial risk for increased morbidity if there is no evidence of active infection, as characterized clinically by pain and suppuration. Hyperbaric oxygen therapy, given to a few patients, has only infrequently shown clinical efficacy (25,27,28,32,33,36,69).…”

Section: Management Recommendationsmentioning

confidence: 99%

Systematic Review: Bisphosphonates and Osteonecrosis of the Jaws

2006

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Osteonecrosis of the jaws is a recently described adverse side effect of bisphosphonate therapy. Patients with multiple myeloma and metastatic carcinoma to the skeleton who are receiving intravenous, nitrogen-containing bisphosphonates are at greatest risk for osteonecrosis of the jaws; these patients represent 94% of published cases. The mandible is more commonly affected than the maxilla (2:1 ratio), and 60% of cases are preceded by a dental surgical procedure. Oversuppression of bone turnover is probably the primary mechanism for the development of this condition, although there may be contributing comorbid factors. All sites of potential jaw infection should be eliminated before bisphosphonate therapy is initiated in these patients to reduce the necessity of subsequent dentoalveolar surgery. Conservative débridement of necrotic bone, pain control, infection management, use of antimicrobial oral rinses, and withdrawal of bisphosphonates are preferable to aggressive surgical measures for treating this condition. The degree of risk for osteonecrosis in patients taking oral bisphosphonates, such as alendronate, for osteoporosis is uncertain and warrants careful monitoring.

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“…Studies have indicated that bacterial infections have a role in ONB (23,24) . Colonization by Actinomyces, Staphylococcus aureus and Streptococcus sp (25) and by bacteria of the normal flora of the oral cavity (21) has been detected.…”

Section: Introductionmentioning

confidence: 99%