Bone metabolism and clinical study of 44 patients with bisphosphonate-related osteonecrosis of the jaws

Abstract

Osteonecrosis of the jaws is a clinical entity described and linked to treatment with bisphosphonates in 2003. Its real incidence is unknown and it could increase due to the large number of patients treated with these drugs, and its cumulative effect on the bone. State of the art knowledge regarding its etiopathogeny, clinical course and suitable treatments is limited. Objectives: To study the clinical characteristics of 44 patients with bisphosphonate-related osteonecrosis of the jaws and the state of their bone mineral metabolism: bone remodeling state, prevalence of fractures, bone mineral density study, and assessment of the different treatment strategies. Design of the Study: Observational. Information was gathered prospectively through interviews, clinical examinations, additional tests and review of medical records. Results: We studied 16 men and 28 women with a mean age of 64.7 years. Breast cancer was the most frequent underlying disease. Zoledronate was used in 82% of the cases and in the non-oncology group of patients; alendronate was the most frequently used bisphosphonate. The mean duration of the zoledronate and alendronate treatments was 25 months and 88 months respectively. The lower jaw was the most frequent location, and previous exodontias—among the triggering factors known—were the most closely linked to its onset. We found considerable osteoblastic activity in patients suffering from neoplasia, with artifacts present in their bone densitometry and a high percentage of vertebral fractures. Conclusions: According to our results, osteonecrosis of the jaws affects elderly patients. We found a direct relationship between the duration of exposure and the accumulated dose. Other relevant factors are: Poor oral and dental health, corticoids, diabetes and teeth extractions. In essence, it is a clinical diagnosis. Prevention is the best strategy to handle this clinical entity. Key words:Alendronate, bisphosphonate, jaw, maxilla, osteonecrosis, osteoporosis, prevention, zoledronate.

Epidemiology, Pharmacology and Clinical Characterization of Bisphosphonate-related Osteonecrosis of the Jaw. A Retrospective Study of 70 Cases

“…This study differs from our results in the lower percentage of cases submitted to surgical treatment (39%) and surgically less ''aggressive''. Unfortunately, it is not possible to compare the evolution of the series because the information detailed by Bocanegra et al 8 only specifies that 45% of the patients remain stable after the treatment and 23% of them did not improve despite the treatment applied.…”

“…6 Along the same line and more recently, two further BRONJ case series have been published in Spain, one of which contains clinical and epidemiological information from the northwest of Spain, the Galician provinces, 7 and the other from Canary Islands. 8 Moreover, in 2012 Bagan et al 9 reported a case series of 126 patients with BRONJ and 19% of them had developed their disease in relation to oral intake of aminobisphosphonates.…”

Evaluation of socket healing in patients undergoing bisphosphonate therapy: Experience of a single Institution

“…Several studies have reported tooth extraction as a potential risk factor for the development of BOJ (6,8-10). The incidence of BOJ associated with exodontias varies between 36.7% and 73% of reported cases (11-13).…”

Avaliação da qualidade óssea mandibular em crianças com osteogênese imperfeita em uso de pamidronato

“…Há relatos de que o tratamento prolongado com os bisfosfonatos pode resultar em achados característicos da osteopetrose, como densidade óssea aumentada e remodelação defeituosa, as quais persistem por mais de 18 meses após a interrupção do tratamento (Mariani, 2003). Outro efeito adverso relatado na literatura é a osteonecrose de maxila e mandíbula associada ao uso dos bisfosfonatos (Hoff et al, 2008;Bocanegra-Pérez et al, 2012).…”

“…A real incidência dessa complicação permanece desconhecida, mas estudos prévios têm mostrado uma relação direta com a duração do tratamento e a dose administrada, além de saúde bucal comprometida e extrações dentárias (Hoff et al, 2008;Bocanegra-Pérez et al, 2012). Até os dias atuais, não foram reportados casos de osteonecrose em mandíbulas de crianças portadoras de OI tratadas com bisfosfonatos, mesmo após 10 anos de tratamento (Malmgren et al, 2008;Schwarz et al, 2008;Maines et al, 2012).…”