A different schedule of zoledronic acid can reduce the risk of the osteonecrosis of the jaw in patients with multiple myeloma

Abstract

Osteonecrosis of the jaw (ONJ) is a reported complication of bisphosphonate use. The incidence ranges between 6 and 13% and seems to be higher in people treated with zoledronic acid (ZA) than with pamidronate. We retrospectively evaluated the incidences of ONJ and skeletal-related events (SRE) in 106 patients with multiple myeloma divided in two groups according to the schedule of administration of bisphosphonates: 51 received monthly administrations until tolerated (group A, standard schedule), 55 were treated monthly during the first year and then every 3 months (group B, reduced schedule). The incidence of SRE was similar (15.1 per 100 person years in group A and 17.7 in group B). ONJ occurred in seven patients, six in group A and one in group B (P ¼ 0.049). The risk of ONJ was eight-fold lower with the reduced schedule than with the standard schedule. The only significant risk factor for ONJ was the type of bisphosphonate (P ¼ 0.006). The incidence of ONJ was significantly higher with ZA than with pamidronate þ ZA (9.1 vs 1.6 per 100 person-years). No ONJ was observed in patients treated only with pamidronate. A reduced schedule of ZA may be safer than the standard schedule while maintaining anti-resorptive efficacy.

Osteonecrosis of jaws related to intravenous bisphosphonates: the experience of a Jordanian teaching hospital

“…3,12,13 The results of this study (9.7%) fall within the reported range. Risk factors for BRONJ include: recent dento-alveolar surgery, 2,14,15 bisphosphonate exposure and frequency of administration, 16,17 potency of the drug, 16,18 local anatomy (mandible more common than maxilla and more common in areas with thin oral mucosa like tori and mylohyoid ridge), 12 oral disease, systemic conditions and co-morbidities, 12,18 and finally genetic factors. 19 All four cases of confirmed BRONJ in this study had dental co-morbidities as inciting event.…”

The Challenge for the Dental Community-Bisphosphonate-Related Osteonecrosis of the Jaw

“…By literature data, the potential of development of osteonecrosis as a result of administration of amino-bisphosphonates (Zoledronate and Pamidronate) is greater than that of non-aminobisphosphonates (Clodronate) [6,7]. Perhaps the most important factor for the occurrence of bisphosphonate-related osteonecrosis of the jaw is the duration of treatment [4,8,9]. Badros et al [10] suggested that the risk of developing bisphosphonate-related necrosis of the jaw was increased by 57% with each year after diagnosing multiple myeloma and starting its treatment.…”

Re: Femurfraktur og kjeveleddsdestruksjon etter bruk av bisfosfonater

“…A retrospective study of a different dose schedule in 106 patients with multiple myeloma found that the risk of developing ONJ was eight-fold lower in patients receiving iv bisphosphonates (zoledronate and/or pamidronate) at a reduced frequency (monthly administration during the first year and then every 3 months) compared to patients receiving iv bisphosphonates according to the monthly administrations (Corso et al, 2007). Further studies are required to optimise the treatment regimen (dose, frequency and duration of therapy) for iv bisphosphonates in order to reduce the risk of ONJ while maintaining clinical efficacy.…”