Bisphosphonate-induced osteonecrosis of the jaws: Prospective study of 80 patients with multiple myeloma and other malignancies

Boonyapakorn, Thacharot; Schirmer, I.; Reichart, Peter A.; Sturm, Isrid; Massenkeil, Gero

doi:10.1016/j.oraloncology.2007.11.012

Cited by 251 publications

(208 citation statements)

References 50 publications

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“…[1][2][3] Since 2003, more than 1000 cases of bisphosphonate-associated osteonecrosis of the jaw have been documented in the literature, [1][2][3][4][5][6][7][8][9][10][11][12] and more than 3500 cases have been reported to the Food and Drug Administration in the US alone. 4,5 Reported prevalence ranges substantially from 0.01% to 28%, [1][2][3][4][5][6][7][8][9] and high variability persists after correction for type/potency of bisphosphonates and underlying diseases (high-potency intravenous in cancer patients vs. low-potency oral bisphosphonates in osteoporosis patients). [1][2][3][4][5][6][7][8][9] This is more likely to reflect inconsistency and flaws in the collection of data rather than real variations in the prevalence among populations.…”

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confidence: 99%

“…4,5 Reported prevalence ranges substantially from 0.01% to 28%, [1][2][3][4][5][6][7][8][9] and high variability persists after correction for type/potency of bisphosphonates and underlying diseases (high-potency intravenous in cancer patients vs. low-potency oral bisphosphonates in osteoporosis patients). [1][2][3][4][5][6][7][8][9] This is more likely to reflect inconsistency and flaws in the collection of data rather than real variations in the prevalence among populations. 7 The lack of specific diagnostic criteria and a unanimously accepted definition of bisphosphonate-associated osteonecrosis of the jaw is possibly the major cause of this epidemiological inconsistency.…”

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confidence: 99%

“…[1][2][3][4][5][6][7][8][9] This is more likely to reflect inconsistency and flaws in the collection of data rather than real variations in the prevalence among populations. 7 The lack of specific diagnostic criteria and a unanimously accepted definition of bisphosphonate-associated osteonecrosis of the jaw is possibly the major cause of this epidemiological inconsistency. Usually, bisphosphonate-associated osteonecrosis of the jaw is defined as an area of exposed bone in the maxillofacial region that does not heal within 6-8 weeks in a patient who is receiving or has been exposed to bisphosphonate medications (but not to radiotherapy to the head and neck).…”

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confidence: 99%

“…Usually, bisphosphonate-associated osteonecrosis of the jaw is defined as an area of exposed bone in the maxillofacial region that does not heal within 6-8 weeks in a patient who is receiving or has been exposed to bisphosphonate medications (but not to radiotherapy to the head and neck). [1][2][3][4][5][6][7][8]13 It has been described as avascular bone necrosis from histopathology reports, although biopsy is usually not required for its diagnosis. [1][2][3]13 More recently, however, there have been reports suggesting that bisphosphonate-associated osteonecrosis of the jaw, especially in its early stages, can manifest signs and symptoms in absence of bone exposure.…”

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confidence: 99%

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Nonexposed Variant of Bisphosphonate-associated Osteonecrosis of the Jaw: A Case Series

Fedele

Porter

D’Aiuto

et al. 2010

The American Journal of Medicine

218

150

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PURPOSE:To report a case series of patients with the nonexposed variant of bisphosphonate-associated osteonecrosis of the jaw-a form of jaw osteonecrosis that does not manifest with necrotic bone exposure/ mucosal fenestration. METHODS: Among 332 individuals referred to 5 clinical centers in Europe because of development of jawbone abnormalities after or during exposure to bisphosphonates, we identified a total of 96 patients who presented with the nonexposed variant of osteonecrosis. Relevant data were obtained via clinical notes; radiological investigations; patients' history, and referral letters. RESULTS:The most common clinical feature of nonexposed osteonecrosis was jaw bone pain (88/96; 91.6%); followed by sinus tract (51%), bone enlargement (36.4%); and gingival swelling (17.7%). No radiological abnormalities were identified in 29.1% (28/96) of patients. In 53.1% (51/96) of the patients; nonexposed osteonecrosis subsequently evolved into frank bone exposure within 4.6 months (mean; 95% confidence interval; 3.6-5.6). CONCLUSIONS: Clinicians should be highly vigilant to identify individuals with nonexposed osteonecrosis, as the impact on epidemiological data and clinical trial design could be potentially significant. Although the present case series represents approximately 30% of all patients with bisphosphonates-associated osteonecrosis observed at the study centers, further population-based prospective studies are needed to obtain robust epidemiological figures.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Nonexposed Variant of Bisphosphonate-associated Osteonecrosis of the Jaw: A Case Series

Fedele

Porter

D’Aiuto

et al. 2010

The American Journal of Medicine

218

150

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“…Cependant, il est important de noter qu'il s'agit d'études rétrospectives portant sur de petits effectifs insuffisants [8] et que plusieurs études rapportent des incidences plus importantes, jusqu'à 28 % [9,13,14]. Ces écarts pourraient résulter d'une approche méthodologique différente entre les études : durée de suivi des patients, modalités du dépistage des ONM, etc.…”

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Intérêt de l’oxygénothérapie hyperbare dans la prévention et le traitement des ostéonécroses des maxillaires dues aux bisphosphonates

Gunepin

Derache

Cathelinaud

et al. 2013

Med Buccale Chir Buccale

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Résumé -Les bisphosphonates (BP) sont des inhibiteurs du remodelage osseux indiqués dans la prise en charge de pathologies malignes (myélome multiple, métastases de tumeurs solides, etc.) et bénignes (ostéoporose, maladie de Paget, etc.). Depuis 2003, un effet indésirable imputé à cette classe de médicaments est apparu dans la littérature : les ostéonécroses des maxillaires (ONM) induites par la prise de BP. Cliniquement, l'ONM se caractérise par une exposition d'os nécrotique qui persiste pendant plus de 8 semaines. En 2007, puis 2009, l'American Association of Oral and Maxillofacial Surgeons (AAOMS) a émis des recommandations destinées aux professionnels de santé pour prévenir et prendre en charge cet effet indésirable. Cependant, l'absence de thérapeutiques efficaces a poussé de nombreux auteurs à tester, en complément des thérapies proposées par l'AAOMS, des traitements expérimentaux au nombre desquels figure l'oxygénothérapie hyperbare (OHB). D'un point de vue théorique, l'étiopathogénie des ONM n'étant pas connue, l'impact de l'OHB sur les mécanismes de survenue de cette pathologie reste hypothétique. D'un point de vue clinique, les avis divergent sur l'intérêt de l'utilisation de l'OHB dans le traitement des ONM. Cependant, les résultats préliminaires de deux essais cliniques contrôlés et randomisés en cours aux Etats-Unis laissent à penser que l'OHB pourrait trouver de nouvelles indications en chirurgie orale dans le traitement mais aussi la prévention des ONM.Abstract -Interest of hyperbaric oxygen therapy in the prevention and treatment of bisphosphonate-related osteonecrosis of the jaws. Bisphosphonates (BP) have been used since 1960s for their capability to alter the mechanism of bone resorption and remodeling. Intravenous (IV) BP are effective in the treatment and management of cancer-related conditions including hypercalcemia of malignancy, skeletal-related events associated with bone metastases in the context of solid tumors such as breast cancer, prostate cancer and lung cancer, and management of lytic lesions in the setting of multiple myeloma. Oral BP are used to treat osteoporosis and osteopenia. In 2003, oral and maxillofacial surgeons first recognized and reported cases of non-healing exposed bone in the maxillofacial region in patients treated with IV bisphosphonates. This adverse effect was called BONJ for bisphosphonate-related osteonecrosis of the jaws. Clinically, BONJ is defined by an exposed bone in the maxillofacial region that has persisted for more than 8 weeks. So far, the etiopathogenesis of BONJ remains

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Mandibulectomy and Free Flap Reconstruction for Bisphosphonate-Related Osteonecrosis of the Jaws

Hanasono

Militsakh

Richmon

et al. 2013

JAMA Otolaryngol Head Neck Surg

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Bisphosphonate-related osteonecrosis of the jaws is an increasingly recognized complication of intravenous and oral bisphosphonate therapy that can occasionally progress to involve full-thickness mandibular destruction, pathologic fracture, and fistulization, as well as chronic pain and infection. Mandibulectomy and free flap reconstruction is an effective treatment for patients with stage 3 and recalcitrant stage 2 bisphosphonate-related osteonecrosis of the jaws. High rates of chronic infection and underlying medical comorbidities may predispose to a substantial perioperative complication rate.

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Bisphosphonate-induced osteonecrosis of the jaws: Prospective study of 80 patients with multiple myeloma and other malignancies

Cited by 251 publications

References 50 publications

Nonexposed Variant of Bisphosphonate-associated Osteonecrosis of the Jaw: A Case Series

Nonexposed Variant of Bisphosphonate-associated Osteonecrosis of the Jaw: A Case Series

Intérêt de l’oxygénothérapie hyperbare dans la prévention et le traitement des ostéonécroses des maxillaires dues aux bisphosphonates

Mandibulectomy and Free Flap Reconstruction for Bisphosphonate-Related Osteonecrosis of the Jaws

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