Intravenous bisphosphonate-related osteonecrosis of the jaws: Influence of coadjuvant antineoplastic treatment and study of buccodental condition

Abstract

Objectives: To determine whether coadjuvant antineoplastic treatment can influence the number and size of bone exposures among patients with intravenous bisphosphonate-related osteonecrosis of the jaws (iBRONJ), and to analyze the buccodental condition of these patients. Material and methods: The study sample comprised 67 patients with iBRONJ, 53 patients without iBRONJ receiving treatment with intravenous bisphosphonates, and 36 healthy subjects. In all three groups, measurements were made of the CAO index and of resting whole saliva and stimulated whole saliva. In the patients with iBRONJ, the size (cm) and number of bone exposures were recorded. The data obtained were subjected to analysis of variance (ANOVA), the Mann-Whitney U-test, and multivariate logistic regression analysis. Results: A total of 57.6% of the patients presented single bone exposure, 25.4% presented two, and 17% more than two exposures. The mean exposure size was 2.3±1.9 cm. Neither the bivariate analysis nor the multivariate multiple regression analysis found coadjuvant antineoplastic treatment to exert a statistically significant effect upon the number and size of bone exposures. On the other hand, there were statistically significant differences among the three study groups in relation to the CAO index (p=0.02) and the number of missing teeth (p=0.00). The resting whole saliva and stimulated whole saliva levels were similar in the three groups, though the patients with osteonecrosis of the jaws showed comparatively lower SWS levels. Conclusions: Coadjuvant antineoplastic treatment alone appears to exert no influence upon the size and number of bone exposures in iBRONJ. The patients with this disease show a higher CAO index and a larger number of missing teeth. Key words:Osteonecrosis of the jaws, bisphosphonates, bone exposure, CAO index, resting whole saliva, stimulated whole saliva.

Oxidative stress in bisphosphonate‐related osteonecrosis of the jaws

“…Zoledronic acid also inhibits RANKL expression and migration of osteoclast precursors during osteoclastogenesis . Such reduced bone turnover and resorption facilitate the development of BRONJ after dental surgery or trauma .…”

Interleukin‐6 concentration changes in plasma and saliva in bisphosphonate‐related osteonecrosis of the jaws

“…In 2003, Marx described the first documented cases of bisphosphonate-related osteonecrosis of the jaws (BRONJ). Since then, many authors have published case series and case reports (Junquera et al, 2009;Fedele et al, 2010;Vescovi et al, 2011;Bagan et al, 2012;Margaix-Muñoz et al, 2013) and have proposed protocols to standardize the diagnosis and treatment (Kyrgidis et al, 2009;Ruggiero et al, 2009). Although BRONJ is characterized by inhibition of osteoclast function, particularly in the jaw bones, many issues remain to be clarified to understand the exact pathogenic mechanism underlying BRONJ (O' Ryan and Lo, 2012;Otto et al, 2012).…”

Concept, diagnosis and classification of bisphosphonate-associated osteonecrosis of the jaws. A review of the literature

“…The diagnosis is essentially clinical ( 28 ). On the other hand, it must be taken into account that there may be one or more sites of bone exposure ( 29 ). Furthermore, these sites may remain asymptomatic for prolonged periods of time (weeks, months or even years), or clinical signs and symptoms may manifest before clinically detectable ONJ develops.…”