Osteonecrosis of the Jaw in Multiple Myeloma Patients: Clinical Features and Risk Factors

Badros, Ashraf; Weikel, Dianna; Salama, Andrew; Goloubeva, Olga; Schneider, Abraham; Rapoport, Aaron P.; Fenton, R. G.; Gahres, Natalie; Sausville, Edward A.; Ord, Robert A.; Meiller, Timothy F.

doi:10.1200/jco.2005.04.2465

Cited by 526 publications

(460 citation statements)

References 37 publications

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“…In another retrospective study of 90 MM patients, ONJ was reported in 3% of patients. 12 Bamias et al 11 reviewed 252 patients with cancer, including 100 with MM, who received at least six infusions of bisphosphonate and reported that the incidence of ONJ was 9.9% among the MM patients. None of the patients treated with pamidronate alone experienced this complication.…”

Section: Discussionmentioning

confidence: 99%

“…8 More recently, avascular osteonecrosis of the jaw (ONJ) has been increasingly reported in patients treated with bisphosphonates. [9][10][11][12] This complication usually presents as a non-healing lesion in the oral cavity strictly related to dental procedures. The etiology is still unclear: microcirculatory alterations, a hypercoagulable state or osteomyelitis have been postulated as possible causes.…”

Section: Introductionmentioning

confidence: 99%

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A different schedule of zoledronic acid can reduce the risk of the osteonecrosis of the jaw in patients with multiple myeloma

et al. 2007

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Osteonecrosis of the jaw (ONJ) is a reported complication of bisphosphonate use. The incidence ranges between 6 and 13% and seems to be higher in people treated with zoledronic acid (ZA) than with pamidronate. We retrospectively evaluated the incidences of ONJ and skeletal-related events (SRE) in 106 patients with multiple myeloma divided in two groups according to the schedule of administration of bisphosphonates: 51 received monthly administrations until tolerated (group A, standard schedule), 55 were treated monthly during the first year and then every 3 months (group B, reduced schedule). The incidence of SRE was similar (15.1 per 100 person years in group A and 17.7 in group B). ONJ occurred in seven patients, six in group A and one in group B (P ¼ 0.049). The risk of ONJ was eight-fold lower with the reduced schedule than with the standard schedule. The only significant risk factor for ONJ was the type of bisphosphonate (P ¼ 0.006). The incidence of ONJ was significantly higher with ZA than with pamidronate þ ZA (9.1 vs 1.6 per 100 person-years). No ONJ was observed in patients treated only with pamidronate. A reduced schedule of ZA may be safer than the standard schedule while maintaining anti-resorptive efficacy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A different schedule of zoledronic acid can reduce the risk of the osteonecrosis of the jaw in patients with multiple myeloma

et al. 2007

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“…13 The potential difficulties in creat ing larger problem through injudicious 14 One report has also suggested an increased risk where patients have received two different parenteral preparations sequentially. 15 Although oral bisphosphonates are the most commonly prescribed form of these drugs, the incidence of BON associated with their use represent only approxi mately 11% of reported cases of BON. 16 An expert panel from the American Dental Association 17 has estimated that the risk associated with oral bisphospho nates is in the order of 0.7 per 100,000 prescribed patient years, based on data reported by pharmaceutical companies.…”

Section: Verifiable Cpd Papermentioning

confidence: 99%

Bisphosphonate osteonecrosis of the jaws; an increasing problem for the dental practitioner

2007

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“…56 ONJ appears to be time dependent, correlates with type of bisphosphonate, older age and dental extractions. [57][58][59] No satisfactory therapy is currently available, while surgical therapy may help only a subset of myeloma patients with ONJ. 60 Therefore, patients who receive bisphosphonates should improve their oral hygiene, while oncologists and dentists should be aware of this complication and its management.…”

Section: Osteonecrosis Of the Jaw And Bisphosphonatesmentioning

confidence: 99%

The effect of novel anti-myeloma agents on bone metabolism of patients with multiple myeloma

2007

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Immunomodulatory drugs (IMiDs) and bortezomib have been recently used in the management of patients with both newly diagnosed and relapsed/refractory multiple myeloma. Except of their direct anti-myeloma effect, these agents also alter the interactions between myeloma cells and marrow microenvironment. Several recent studies have investigated their potential effect on myeloma bone disease. Preclinical studies have demonstrated that IMiDs reduce osteoclast formation and function in vitro. Clinical studies have confirmed that thalidomide reduces markers of bone resorption, while lenalidomide induces osteoclast arrest in myeloma patients. However, IMiDs seem to have no effect on osteoblast exhaustion present in myeloma. The proteasome inhibitor bortezomib restores abnormal bone remodeling through the inhibition of osteoclast function and the increase in osteoblast differentiation and activity in vitro. In myeloma patients, bortezomib reduces biochemical markers of bone resorption and normalizes the RANKL/osteoprotegerin ratio, while at the same time increases bone formation markers reducing levels of dickkopf-1 protein.Whether these effects are direct and not only a consequence of the agents' antimyeloma activity is not totally clear. This review summarizes all available data for these attractive agents that combine potent anti-myeloma activity with beneficial effects on bone and may alter the way of management of myeloma-related bone disease.

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Osteonecrosis of the Jaw in Multiple Myeloma Patients: Clinical Features and Risk Factors

Abstract: ONJ appears to be time-dependent with higher risk after long-term use of bisphosphonates in older MM patients often after dental extractions. No satisfactory therapy is currently available. Trials addressing the benefits/risks of continuing bisphosphonate therapy are needed.

Cited by 526 publications

References 37 publications

A different schedule of zoledronic acid can reduce the risk of the osteonecrosis of the jaw in patients with multiple myeloma

A different schedule of zoledronic acid can reduce the risk of the osteonecrosis of the jaw in patients with multiple myeloma

Bisphosphonate osteonecrosis of the jaws; an increasing problem for the dental practitioner

The effect of novel anti-myeloma agents on bone metabolism of patients with multiple myeloma

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