Objectives
The objectives of this study were to define the incidence, pain, and healing in cancer
patients treated with intravenous bisphosphonates.
Study design
The study included long-term follow-up of 99 bisphosphonate-using patients (group
A) and conservative treatment of 67 patients with bisphosphonate-related osteonecrosis
of the jaw (BRONJ, group B) using 3 antibiotic schemes and oral hygiene.
Results
The frequency of zoledronic acid single-agent use was 85.9% and 69.8% in group A and
B, respectively. Median follow-up was 13 months (group A) and 16 months (group B).
Two patients in group A developed BRONJ (2%). Of those with BRONJ in group B who completed
follow-up, healing occurred in 14.9% (7/47) and pain subsided in 80.9% (38/47). Healing
was significant in patients who received pamidronate followed by zoledronic acid (P = .023) and with BRONJ stages 0 and stage I (P = .003).
Conclusions
This case series suggests that oral hygiene and conservative antibiotic therapy play
a role in healing and pain alleviation in BRONJ. Oral hygiene and follow-up may decrease
incidence of BRONJ.
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References
- Bisphosphonate osteonecrosis (BON): unanswered questions and research possibilities.Rev Recent Clin Trials. 2009; 4: 99-109
- American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws—2009 update.J Oral Maxillofac Surg. 2009; 67: 2-12
- A systematic review of bisphosphonate osteonecrosis (BON) in cancer.Support Care Cancer. 2010; 18: 1099-1106
- Osteonecrosis of the jaws associated with cancer chemotherapy.J Oral Maxillofac Surg. 2003; 61: 1104-1107
- Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases.J Oral Maxillofac Surg. 2004; 62: 527-534
- Avascular jaw osteonecrosis in association with cancer chemotherapy: a series of 10 cases.J Oral Pathol Med. 2005; 34: 120-123
- Bisphosphonate-associated osteonecrosis of mandibular and maxillary bone.Cancer. 2005; 104: 83-93
- Oral osteonecrosis associated with the use of ibandronate: report of a case and clinical implications.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106: e18-e21
- Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors.J Clin Oncol. 2005; 23: 8580-8587
- Osteonecrosis of the jaw and bisphosphonates.N Engl J Med. 2005; 353: 99-102
- Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia.J Oral Maxillofac Surg. 2007; 65: 415-423
- Prevalence and risk factors of bisphosphonate-associated osteonecrosis of the jaw in prostate cancer patients with advanced disease treated with zoledronate.Eur Urol. 2008; 54: 1066-1072
- Bisphosphonate-induced osteonecrosis of the jaws: prospective study of 80 patients with multiple myeloma and other malignancies.Oral Oncol. 2008; 44: 857-869
- Bisphosphonate-related osteonecrosis of the jaws: a case-control study of risk factors in breast cancer patients.J Clin Oncol. 2008; 26: 4634-4638
- Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw.J Clin Oncol. 2009; 27: 5356-5362
- Initial experience with conservative treatment in cancer patients with osteonecrosis of the jaw (ONJ) and predictors of outcome.Ann Oncol. 2009; 20: 331-336
- Prevalence of bisphosphonate associated osteonecrosis of the jaws in multiple myeloma patients.Head Face Med. 2010; 6: 11
- Incidence of osteonecrosis of the jaw in patients with multiple myeloma and breast or prostate cancer on intravenous bisphosphonate therapy.J Oral Maxillofac Surg. 2007; 65: 1328-1331
- A retrospective study assessing the incidence, risk factors and comorbidities of pamidronate-related necrosis of the jaws in multiple myeloma patients.Ann Oncol. 2007; 18: 2015-2019
- Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates.J Bone Miner Res. 2008; 23: 826-836
- Incidence of bisphosphonate-associated osteonecrosis of the jaws in breast cancer patients.Cancer. 2009; 115: 1631-1637
- Incidence, risk factors and management of osteonecrosis of the jaw in patients with multiple myeloma: a single-centre experience in 303 patients.Br J Hematol. 2006; 134: 620-623
- Zoledronate and other risk factors associated with osteonecrosis of the jaw in cancer patients: a case-control study.J Oral Maxillofac Surg. 2008; 66: 625-631
- Osteonecrosis of the maxilla and mandible in patients with advanced cancer treated with bisphosphonate therapy.Oncologist. 2008; 13: 911-920
- Osteonecrosis of the jaw (ONJ) in cancer patients treated with bisphosphonates: how the knowledge of a phenomenon can change its evolution.Support Care Cancer. 2008; 16: 1311-1315
- Systematic review: bisphosphonates and osteonecrosis of the jaws.Ann Intern Med. 2006; 144: 753-761
- Practical guidelines for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in patients with cancer.J Oncol Pract. 2006; 2: 7-14
- Bisphosphonate-related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102: 433-441
- Osteonecrosis of the jaw complicating bisphosphonate treatment for bone disease in multiple myeloma: an overview with recommendations for prevention and treatment.Intern Med J. 2009; 39: 304-316
- Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper.J Am Dent Assoc. 2005; 136: 1658-1668
- Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zolendronic acid.Ann Oncol. 2009; 20: 117-120
- Decreased occurrence of osteonecrosis of the jaw after implementation of dental preventive measures in solid tumor patients with bone metastases treated with bisphosphonates.Ann Oncol. 2009; 20: 137-145
- Natural history of osteonecrosis of the jaw in patients with multiple myeloma.J Clin Oncol. 2008; 26: 5904-5909
- Osteonecrosis of the jaws due to bisphosphonate use.Am J Otolaryngol. 2007; 28: 158-163
Article info
Publication history
Published online: May 30, 2011
Footnotes
Conflict of interest: Cesar A. Migliorati is a consultant for Amgen, Inc.
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.