Longitudinal Cohort Study of Risk Factors in Cancer Patients of Bisphosphonate-Related Osteonecrosis of the Jaw

Abstract

The conclusions of this study validated dental extractions and use of dentures as risk factors for ONJ development. Ibandronate and pamidronate at the dosages and frequency used in this study seem to exhibit a safer drug profile concerning ONJ complication; however, randomized controlled trials are needed to validate these results. Before initiation of a bisphosphonate, patients should have a comprehensive dental examination. Patients with a challenging dental situation should have dental care attended to before initiation of these drugs.

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

“…[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.…”

“…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.…”

“…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.…”

Bisphosphonate-related osteonecrosis of the jaw in randomized clinical trials

“…It is noteworthy that the authors managed through a well-conducted meta-analysis to detect this outcome in a population with a very low incidence rate. In a recently published prospective epidemiological study from Northern Greece, in which ONJ is the primary outcome, the incidence of ONJ is reported to be elevated in those patients receiving zolendronate when compared to patients receiving pamidronate and especially ibandronate [5]. The authors concluded that future RCTs should verify this outcome [5], and the meta-analysis by Mauri et al supports this argument.…”

“…Reading [4], increasing bisphosphonate accumulation in the skeleton with time may lead to ONJ development. Incidentally, the majority of ONJ cases are reported to occur after administration of over six bisphosphonate doses [5].…”