BACKGROUND: Bisphosphonate therapy is indicated in the treatment of patients with symptomatic bony disease secondary to multiple myeloma, solid tumors and in the chronic management of osteoporosis. We have previously reported our early experience with bisphosphonate related osteonecrosis of the jaw (

J Oral Maxillofac Surg 2004; 62:527–534
). This entity is now being recognized more commonly by treating hematologists/ oncologists and dental medicine community and the incidence of this complication has been reported between 4–10% among those patients receiving chronic intravenous bisphosphonate therapy. BRON is associated with significant morbidity in cancer patients and often requires symptomatic management for local palliation. The purpose of our current study is to update our previously reported experience at our institution and to review preventative and symptomatic management of this entity.

METHODS: We performed a retrospective analysis of patient records identified to have BRON at our institution. Institutional Review Board approval was obtained for this study. Information regarding age, gender, indication for bisphosphonate treatment, type of bisphosphonate agent used, clinical manifestation and management of osteonecrosis were recorded.

RESULTS: One hundred and two patients with BRON were identified at our institution. Median age was 67 years (range 40–89); Males: n=31; Females: n=71; Indications for bisphosphonate therapy: Multiple myeloma (n=40); Breast cancer (n=39), Prostate cancer (n=6), Uterine sarcoma (n=1), Connective tissue disorders (n=2), osteoporosis (n=14). Prior bisphosphosphonate therapy included: Pamidronate (n=28); Zoledronate (n=29); Pamidronate and Zoledronate therapy (n=31), and oral bisphosphonates (n=14). 24 of 102 patients had also received steroid therapy at some time during their clinical course. Most common presentation was a non healing extraction socket. Forty of 102 patients presented after surgical trauma to the jaw bone. Biopsies, when performed, confirmed the presence of osteonecrosis. No patients in this series had received radiation therapy to the jaw or had evidence of metastatic disease to the jaw bone. Surgical debridement was neccessary in 28 of 102 patients for local control of symptoms. Other patients were managed conservatively with antibiotics and local irrigation.

CONCLUSION: Long term intravenous and oral bisphosphonate therapy is associated with osteonecrosis of the jaw bone. Surgical trauma to the jaw bone may be associated with poor post-operative healing in these patients. Physicians and patients need to be aware of this significant potential complication of this therapy which may result in significant morbidity and impaired quality of life for these patients. Most patients can be managed conservatively, however, a significant fraction require surgical debridement for local palliation.

Topics:
bisphosphonates, jaw, osteonecrosis, surgical procedures, operative, debridement, multiple myeloma, osteoporosis, palliative care, pamidronate, wounds and injuries

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2005, The American Society of Hematology
2005
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