Osteonecrosis of the Jaw in Patients with Bone Metastases Treated with Bisphosphonates: A Retrospective Study

Abstract

After completing this course, the reader will be able to:1. Discuss the importance of treating patients with bone metastases using a multidisciplinary approach.2. Explain why bisphosphonates are a fundamental part of bone metastasis treatment.3. Evaluate the main features of ONJ and, in particular, its high risk factor. 4. Describe the importance of ONJ prevention during bisphosphonate treatment.5. Emphasize the importance of interaction among the patient's dentist, surgeon, and oncologist for the management of ONJ.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME Results. The eight patients with ONJ had all been given zoledronic acid, and two had also been treated with pamidronic acid. In four of the patients, ONJ was diagnosed during treatment, while in the remaining four it was diagnosed several months after therapy with bisphosphonates had ended. Six of these patients received local noninvasive treatment, of whom five progressed. Two showed apparent autolimitation of the disease. The remaining two patients underwent surgical resection and currently show no signs of relapse. All eight ONJ patients presented with various concomitant risk factors such as paradontopathy, dental extraction, or spontaneous avulsion. ABSTRACTConclusions. Our results show that ONJ can appear months after interruption of treatment and that a surgical approach can be used in suitable cases. Closer cooperation is needed among specialists to define guidelines for the prevention of ONJ in patients with bone metastases. The Oncologist 2008;13:330 -336

Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review

“…Medical treatment of BRONJ was reported in 49 publications 17,27,44,49,59,68,69,72,73,76,80,86,[88][89][90]95,[100][101][102][104][105][106][107][108][109][110]113,114,117,118,122,[125][126][127][128][129][130][131]134,135,138,139,141,144,145,150,[152][153][154] and minimally invasive surgical treatment in 44 publications . 17,27,…”

“…15 Bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been characterized as a main side effect of BP therapy. [16][17][18] The first descriptions of BRONJ were reported in 2003. [19][20][21] Since then, numerous reports on the development of osteonecrosis of the jaw in patients treated with BPs have been published.…”

A case of osteonecrosis of the jaw in a breast cancer patient with bone metastases receiving long-term treatment with bisphosphonates

“…The onset of ONJ in this case was at 16 months of treatment, which is relatively early; this suggested a possible onset despite short duration of treatment. In addition, Ibrahim reported that ONJ could appear months after interruption of BP treatment [12]. According to a retrospective analysis by the MD Anderson Cancer Center, [13] the prevalence of ONJ is 0.73% (29/3994).…”

“…There is no effective treatment established for ONJ, which puts great importance in preventative measures at the initiation of BP treatment and adequate treatment after onset to avoid exacerbation. There is a strong need for specialists to define guidelines for the prevention of ONJ in patients treated with BPs, [12]. Collaboration between the oncology and dental personnel is integral in patient education and treatment management [1,7].…”

Ostéonécroses des maxillaires dues aux bisphosphonates administrés par voie intraveineuse : incidence et facteurs de risque

“…Actuellement, l'incidence des ONM communément admise, notamment par l'Agence Nationale de Sécurité des Médicaments et des produits de santé (ANSM) [16], chez les patients traités pour une pathologie maligne par BP IV, se situe entre 0,8 et 12 % [17,[26][27][28][29][30][31][32]. Cette incidence repose sur de nombreuses études publiées entre 2005 et 2009 [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48].…”