“Osteonecrosis of the Jaw: Experience of a Single center”.

Bisphosphonates have been proven to be effective in preventing or delaying skeletal complications in multiple myeloma with a significant improvement of the quality of life. Although these agents are usually well tolerated, osteonecrosis of the jaw (ONJ) has been recently associated with the use of bisphophonates. Nevertheless, the true incidence of this complication is not clearly defined. Therefore, we studied the incidence, characteristics and risk factors for the development of ONJ among patients with multiple myeloma treated with biphosphonates in our institution.

Five-hundred and sixteen patients who received biphosphonates (zoledronic acid, pamidronate, bondronate) and had a minimum exposure of 6 months to the drug were included in this analysis. These patients were asked reterospectivly to fill out a form containing several queries, including sex and age, type and time of neoplasia diagnosis, treatment and neoplasia status, odonthoiatric anamnesis, type and duration of therapy with BP, microbial isolation in site of lesion, specific treatment for osteonecrosis, number of patients (pts) affected by MM treated with BP from 2007 to 2009. From this retrospective review thirty-five patients were identified with pain of the jaw.

Two-hundred of five-hundred and sixteen patients received bondronate, seventy-four patients pamidronate, one-hundred and seventy-four patients zoledronic acid, twenty-three patients oral bisphosphonate and two patients are unable to name the bisphosphonate. Thirty-five patients were identified with pain of the jaw. A total of twenty-five ONJ cases were identified either by histology or estimation of the surgeon among all patients treated and referred to our institute. Five patients had no ONJ, only non-specific pain of the jaw. Five patients have other disease of the jaw (1 patient osteoymelitis; 1 patient cyst of the jaw; 1 patient epulis gigantocellularis, 1 patient granuloma, 1 patient plasmozytoma of the jaw). Ten patients who were diagnosed with ONJ received bondonate, eleven patients pamidonate and thirteen patients zoledronic acid. The majority of the ONJ lesions completely healed in 24 patients. Overall, most of the ONJ lesions were associated with dental procedures and pain was the symptom most frequently reported.

ONJ is a serious complication of bisphosphonate therapy. But with active monitoring for ONJ and early input from dental experts, ONJ has been mild to moderate in severity, had minimal impact on overall quality of life and improved or healed in the majority of patients. These results suggest that with proper management, ONJ is a manageable, infrequent complication that may be associated with a reduced SRE (skeletal-related events) risk and improved overall survival. Length of exposure and the probably the type of biphosphonate used appear to be the most important risk factor for this complication.

Goldschmidt:Johnson and Johnson: Research Funding, Speakers Bureau.