Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome

Yarom, Noam; Yahalom, Ran; Shoshani, Yitzhak; Hamed, Waleed; Regev, Eran; Sharon, Elad

doi:10.1007/s00198-007-0384-2

Cited by 197 publications

(176 citation statements)

References 25 publications

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“…Less uniform is the percentage of BRONJ among non-cancer, osteoporotic patients within whole samples also comprising cancer patients: in a multi-center study, a BRONJ frequency of 7.1% in patients treated with oral BP therapy [41] was reported; a frequency of 8.9% of BRONJ after per os BP administration was observed in two Israeli medical centers; and, of all the BRONJ patients in other case series reported in the literature, the percentage of orally-administered bisphosphonate-induced ONJ ranges from 2.5% to 27.3% [58]. In the absence of reliable statistics indicating the number of patients exposed to BPs, it is still not easy to establish the real risk of developing BRONJ for non-cancer patients, also due to the large number of supposed and still unascertained risk factors.…”

Section: European Journal Of Internal Medicine 24 (2013) 784-790mentioning

confidence: 99%

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Fede

Fusco

Matranga

et al. 2013

European Journal of Internal Medicine

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Section: European Journal Of Internal Medicine 24 (2013) 784-790mentioning

confidence: 99%

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Fede

Fusco

Matranga

et al. 2013

European Journal of Internal Medicine

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“…11 The dentist must educate the patient preparing to undergo any chemotherapy regimen about the possible dental side effects of BP and take the necessary preventive measures to keep potential side effects to a minimum. 12 The role of hyperbaric oxygen therapy is still unclear but some benefits of this treatment have recently been described in association with discontinuation of BP therapy and conventional therapy (medical or/and surgical). 13 Surgical treatment, in accordance to the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper, is reserved to patients affected by Stage III of BRONJ even if in the last version a superficial debridement is indicated to relieve soft tissue irritation also in the Stage II (lesions being unresponsive to antibiotic treatment).…”

Section: Discussionmentioning

confidence: 99%

Surgical management in patients with bisphosphonate-related osteonecrosis of the jaw: four cases

Dikicier¹,

Karaçaylı²

2014

Cumhuriyet Dent J

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Bisphosphonates, which have been introduced into medicine in the early 1990's, is now being used succesfully for treatment of primary osteolitic bone diseases such as metastathic diseases, multipl myeloma, paget disease, hypercalsemia in malingnancies and management of pain occuring in these bone pathologies. Their half-life in circulation is very short, but they can stay for years in bone tissue. On the other hand, reports about bisphosphonate-related osteonecrosis of the jaw has been increasingly published recently. In this case report, bisphosphonate-related osteonecrosis of the jaw and treatment modalities has been evaluated in four cases.

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“…As ONJ is now a well-known adverse effect of intravenous biphosphonates, one can be falsely reassuring about the safety of oral biphosphonates. According to Yarom et al, of all the ONJ patients in case series reported in the literature, the relative proportion of orally administrated biphosphonate-induced ONJ ranges from 2.5 to 27.3% [25]. In most cases, alendronate, an aminobiphosphonate, was the oral biphosphonate mentioned because it is the most widely used oral biphosphonate.…”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the jaw induced by clodronate, an alkylbiphosphonate: case report and literature review

Crépin

Laroche

et al. 2010

Eur J Clin Pharmacol

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Purpose To report on a case of osteonecrosis of the jaw (ONJ) in a patient treated with clodronate, an alkylbiphosphonate, and to draw attention to the risk of ONJ following treatment with all biphosphonates, whether they are alkyl-or amino-biphosphonates. Case report Beginning at age 58 years, a female patient took clodronate for almost 13 years for a metastatic bone cancer. She also underwent chemotherapy and radiotherapy. Three months after the end of biphosphonate therapy, she suffered from toothache, and tooth 27 (left maxillary second molar) was extracted. A maxillary focus of osteitis with an oral sinus communication was discovered, and a maxillofacial denture prosthesis was grafted in September 2006. Some days later, the patient consulted her dentist for an ulceration of the oral cavity floor in front of tooth 33 (left mandibular canine) extending to the left inferior side of the lip. In October 2006, teeth 33 and 34 (left mandibular first premolar) were extracted. No secondary infection occurred. A complete healing was only observed 3 months after the last extraction. ONJ due to alkylbiphosphonate treatment was diagnosed as bone reconstruction and mucous cicatrisation were delayed. Methods A systematic review was carried out to identify all cases of alkylbiphosphonate-induced ONJ by searching the Medline and Cochrane databases using 'osteonecrosis of the jaw', 'jaw diseases', 'osteonecrosis', 'diphosphonate', 'biphosphonate' (amino-, alkyl-or the international nonproprietary name) as the main search items. The search was limited to English-and French-language articles published between 1966 and February 2010. Results Our search identified 27 cases of alkylbiphosphonateinduced ONJ in the literature. Among these cases, only ten patients were on alkylbiphosphonate monotherapy; in the other cases, aminobiphosphonates had also been used. The clinical presentation of the alkylbiphosphonate-induced ONJ was similar to that most often encountered with aminobiphosphonate treatment. The duration of exposure before onset was higher with alkylbiphosphonates than with aminobiphosphonates, and dental procedures before ONJ were frequent. Conclusion Osteonecrosis of the jaw has been widely reported with various aminobiphosphonates, but data on the role of alkylbiphosphonates are scarce. As these latter drugs are less potent, a high cumulative dose through long-term exposure would appear to be necessary and would favour ONJ. Although the degree of risk for ONJ occurrence in patients on alkylbiphosphonates remains uncertain, it would be wise to reconsider carefully the indications for using these agents and to apply preventive measures as is currently done for aminobiphosphonates.

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Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome

Cited by 197 publications

References 25 publications

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Surgical management in patients with bisphosphonate-related osteonecrosis of the jaw: four cases

Osteonecrosis of the jaw induced by clodronate, an alkylbiphosphonate: case report and literature review

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