Incidence, risk factors and management of osteonecrosis of the jaw in patients with multiple myeloma: a single‐centre experience in 303 patients

Zervas, Kostas; Verrou, Evgenia; Teleioudis, Zisis; Vahtsevanos, Konstantinos; Banti, Anastasia; Mihou, Dimitra; Krikelis, Dimitrios; Terpos, Evangelos

doi:10.1111/j.1365-2141.2006.06230.x

Cited by 266 publications

(203 citation statements)

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“…Nitrogencontaining bisphosphonates (intravenous zoledronic acid or pamidronate), together with other treatment options, are used widely for the treatment of these negative skeletal events [1]. In 2003, after an alert initial observation by Wang et al [2] at the University of California San Francisco, Rosenberg and Ruggiero [3], Marx [4] and Migliorati [5] have reported unusual findings of osteomyelitis-like lesions of the jaws in a set of patients affected by multiple myeloma and metastatic bone disease; subsequently, several papers have confirmed the initial observations and called this condition bisphosphonaterelated osteonecrosis of the jaws (BRONJ) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. All the initial observations have pointed to the potential role of the intravenously administered bisphosphonates such as pamidronate and zoledronate.…”

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confidence: 78%

Bisphosphonate-related Osteonecrosis of the Jaws: An Update on Clinical, Pathological and Management Aspects

Ficarra

Beninati

2007

Head and Neck Pathol

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Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is mainly observed in patients with multiple myeloma and bone metastasis from solid tumors receiving iv bisphosphonate therapy. The reported incidence of BRONJ is significantly higher with the iv preparations zoledronic acid and pamidronate while the risk appears to be minimal for patients receiving oral bisphosphonates. Currently available published incidence data for BRONJ are based on retrospective studies and estimates of cumulative incidence range from 0.8 to 12%. The mandible is more commonly affected than the maxilla (2:1 ratio), and

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confidence: 78%

Bisphosphonate-related Osteonecrosis of the Jaws: An Update on Clinical, Pathological and Management Aspects

Ficarra

Beninati

2007

Head and Neck Pathol

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“…Du fait de leur effet bénéfique dans la réduction de la résorption osseuse et du risque de fractures pathologiques, leur prescription est très fréquente (plus de 190 millions de prescriptions de bisphosphonates oraux dans le monde) [3]. L'ostéonécrose des maxillaires associée aux bisphosphonates est une complication plus rare par traitement oral dans des indications bénignes que par traitement intraveineux dans des indications malignes : prévalence entre 1/100 000-1/10 000 [4] et 0,10 % [5] par voie orale contre 0,72 % à 11 % par voie intraveineuse [6][7][8][9]. Les chiffres diffèrent beaucoup en fonction du type d'étude (études prospectives ou rétrospectives, séries de cas), des caractéristiques des patients inclus et du pays [10].…”

Section: Introductionunclassified

Ostéonécrose des maxillaires : quand l’ancien traitement avec bisphosphonates est méconnu

Renoux

Folliguet

Nguyen

et al. 2014

Med Buccale Chir Buccale

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Résumé -Introduction :La personne âgée est atteinte de polypathologies et polymédiquée. Les prescriptions sont faites par plusieurs médecins qui s'ignorent réciproquement, ce qui augmente le risque d'effets adverses. Observation : Le cas d'une patiente de 91 ans vivant dans un établissement d'hébergement pour personnes âgées dépendantes est rapporté. Quatre mois après une perfusion de zolédronate suite à une chute avec tassement vertébral, elle a consulté pour une gêne maxillaire gauche, ce qui a permis de découvrir un foyer d'ostéonécrose spontanée maxillaire. Un deuxième foyer d'ostéonécrose, mandibulaire, a été diagnostiqué trois semaines plus tard. Considérant l'âge de la patiente et l'absence de troubles fonctionnels, seul un débridement chirurgical superficiel a été réalisé. Discussion : L'apparition d'ostéonécroses spontanées bimaxillaires quatre mois après une perfusion unique de zolédronate étant peu probable, la recherche approfondie des antécédents de la patiente a permis de retrouver une prise de trois bisphosphonates oraux pendant sept ans sans aucun examen et suivi bucco-dentaire. L'interrogatoire médical des patients âgés atteints de troubles cognitifs étant difficile, la recherche de tous les médecins prescripteurs est nécessaire. Conclusion : La prise en charge de l'ostéonécrose associée aux bisphosphonates étant complexe, le chirurgien-dentiste joue un rôle important dans la prévention de cette pathologie.Abstract -Osteonecrosis of the jaws: when past bisphosphonates therapy is unknown. Introduction: Older people have multiple morbidities and are polymedicated. The medicines are prescribed by several doctors who are unaware of each other, hence the increased risk of adverse effects. Observation: We report the case of an institutionalized 91-year-old female patient. Following a fall resulting in a vertebral compression fracture, she received an infusion of zoledronic acid. Four months after this treatment, she consulted for left maxillary discomfort. A voluminous bone sequestrum revealed a maxillary osteonecrosis area. Right mandibular osteonecrosis was diagnosed three weeks later. Considering the patient's age and the lack of functional impairment, surgical debridement was the only procedure performed. Discussion: The emergence of spontaneous maxillary osteonecrosis four months after a single infusion of bisphosphonate being implausible, we searched her medical records for the physicians who treated the patient before her institutionalization. We found three oral bisphosphonate medications during seven years. No oral examination was performed during this therapy. The diagnosis of jaw osteonecrosis should lead the oral surgeon to look for past bisphosphonate therapy among other possible etiologies of this pathology. Indeed, this treatment is often forgotten by patients suffering from cognitive impairment. Conclusion: As the management of bisphosphonate-related osteonecrosis of the jaws is difficult, the oral surgeon has an important role in the prevention of this pathology. Mots clés :bisphospho...

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“…[10][11][12] Bu olgu raporunda, intravenöz bifosfonat kullanımı sonucu mandibulada kemik nekrozu geliş-miş 41 yaşında bir hastanın tedavi yaklaşımı sunulmaktadır. sisi (Augmentin ® -BID 1 g, GlaxoSmithKline) altında ilgili alana lokal anestezi (Ultracain ® D-S, Pharma Vision San.…”

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“…9 Oral cerrahi, diş çekimi, dental implant yerleştirilmesi gibi kemik dokuya müdahale gerektiren işlemler lokal risk faktörlerinden en önemlileri olmalarıyla birlikte, kemik eksoztozlarının (lingual ve palatal toruslar) ve adaptasyonunu kaybetmiş protezlerin varlığı da kemik nekrozlarının en önemli lokal etkenlerindendir. [10][11][12] Bu olgu raporunda, intravenöz bifosfonat kullanımı sonucu mandibulada kemik nekrozu geliş-miş 41 yaşında bir hastanın tedavi yaklaşımı sunulmaktadır. …”

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The Treatment of Intravenous Bisphosphonates Induced Osteonecrosis of the Mandible: Case Report

Eroğlu¹,

Alayli²,

Arpak³

2015

Turkiye Klinikleri J Dental Sci

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ifosfonatlar, kemik rezorbsiyonunun potansiyel inhibitörleridir ve yıl-lardır osteoporoz tedavisinde oral yolla kullanılan ilaç gruplarından-dır. Bununla birlikte intravenöz olarak Paget hastalığı, bazı kanserlerin Turkiye Klinikleri J Dental Sci 2015;21(3) 255 İntravenöz Bifosfonat Kullanımına Bağlı Olarak Mandibulada Gelişen Çene Kemiği Nekrozunun Tedavisi Ö ÖZ ZE ET T Bifosfanatlar, kemik turnoverını suprese eden ve osteoporoz gibi bening kemik hastalıkları ve iskeletal yapıyı etkileyen malignensi durumlarını önlemek için yaygın olarak reçete edilen ilaç-lardır. Çenelerin bifosfanat ilişkili osteonekrozu maksilla ve mandibuladaki kemiğin ekspoz olmasıyla karakterize bir durumdur. Bu hastalık; dental implant uygulamaları, apikal rezeksiyon, periodontal cerrahi uygulamalar ve diş çekimi gibi invaziv cerrahi işlemler sonrası ya da alveol kemiğin kendiliğinden ekspoz olması sonucu meydana gelmektedir. Olgumuzda; meme kanseri nedeniyle intravenöz bifosfanat tedavisi görmüş 41 yaşında kadın hasta, sol mandibular premolar ve molar bölgesinde diş çekimi sonrası meydana gelen ağrı ve enflamasyon nedeniyle kliniğimize baş-vurmuştur. Radyografik ve klinik incelemeler sonucu bifosfanat ilişkili osteonekroz tanısı konularak, antibiyotik baskısı altında nekroz alanı cerrahi girişimle temizlenip, iyileşmeyi hızlandırmak için ozon terapisi uygulanmıştır. Nekroz alanının iyileşmesini desteklemek amacıyla hasta hiperbarik oksijen tedavisine yönlendirilmiştir. Bu tedavi prosedürleri sonrası ilgili alanda yeni kemik oluşumu gözlenmiştir. Günümüzde, çene kemiğinin bifosfanat ilişkili osteonekroz olgularında kesin bir tedavi prosedürü bulunmamakla birlikte olgumuzda da gösterildiği üzere hiperbarik oksijen tedavisi bu olgularda umut verici olabilir.A An na ah ht ta ar r K Ke el li im me el le er r: : Çenenin bifosfonat ilişkili osteonekrozu; hiperbarik oksijenasyon; ozon; zoledronik asit A AB BS ST TR RA AC CT T Bisphosphonates are drugs that suppress bone turnover and are commonly prescribed to prevent skeletal related events in malignancy and for benign bone diseases such as osteoporosis. Bisphosphonate-induced osteonecrosis of jaws refers to a condition characterized by exposure of bone in the mandble or maxilla. The disease presents as exposed alveolar bone that occurs spontaneously or becomes evident following on invasive surgical procedure such as tooth removal, periodontal surgery, apicoectomy, or dental implant placement. In our case, 41-year-old woman patient with breast cancer referred to our clinic because of continued pain and inflammation on left mandible after the extraction. After clinical and radiologic examination, she has been diagnosed with biphosphonate induced osteonecrosis of the jaw. Under the pressure of antibiotic, the necrosis area was cleaned surgically and ozone therapy was applied to accelerate the healing. In order to support the healing of the necrosis area, patient have been directed by hyperbaric oxygen therapy. After these treatment procedures, secestre formation in bone and new bone formation ...

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Incidence, risk factors and management of osteonecrosis of the jaw in patients with multiple myeloma: a single‐centre experience in 303 patients

Cited by 266 publications

References 10 publications

Bisphosphonate-related Osteonecrosis of the Jaws: An Update on Clinical, Pathological and Management Aspects

Bisphosphonate-related Osteonecrosis of the Jaws: An Update on Clinical, Pathological and Management Aspects

Ostéonécrose des maxillaires : quand l’ancien traitement avec bisphosphonates est méconnu

The Treatment of Intravenous Bisphosphonates Induced Osteonecrosis of the Mandible: Case Report

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