Bisphosphonate-induced osteonecrosis of the jaws A clinical study of 21 cases
Violetta LIANOU, Maria ALEXOPOULOU, Dimitrios KANOUTOS, Lamprini TROUMPOUKI, Dimitrios PAPAVASILIOU
Oral & Maxillofacial Surgery Clinic. General University Hospital of Patras (Head: D. Papavasiliou)
Hellenic Archives of Oral & Maxillofacial Surgery (2011) 3, 141-154
SUMMARY: Bisphosphonates are the first-line drugs for osteoporosis, as well as for many types of cancer. One of their side-effects is osteonecrosis of the jaw, which has mainly been associated with their intravenous administration. This article features a clinical study of 21 cases of jaw osteonecrosis – 9 male and 12 female patients, with a mean age of 63 years and established bisphosphonate osteonecrosis of the jaws (BONJ), who were treated either conservatively or surgically in the past five years (2005-2010). Of these 21 patients, 17 were on bisphosphonates due to neoplastic disease and another 4 due to osteoporosis. Anti microbial chemotherapy and oral hygiene was the initial treatment for 10 patients with minor symptoms, while a broad spectrum of surgical treatments – from selected tooth extraction under prophylactic administration of antibiotics to marginal resection of necrotic bone – were used in 11 patients with severe bone exposure, infection and masticatory impairment. The majority of the patients who were surgically treated had a satisfactory outcome with no major complications, while 3 patients died from the main disease during the follow-up period. Within this context, we also present in detail the inclusion and taxonomy criteria for this particular disease, as well as our therapeutic protocols, and review the most significant contributions to the literature.
KEY WORDS: bisphosphonates, osteonecrosis of the jaws
REFERENCES
American Association of Oral and Maxillofacial Surgeons Position Pa - per on Bisphosphonate-Related Osteonecrosis of the jaws. J Oral Maxillofac Surg 65;369-376, 2007
American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the jaws. J Oral Maxillofac Surg 67;2-12, 2009
Bagan JV, Murillo J, Jimenez Y, Poveda R, Milian MA, Sanchis JM: Avascular jaw osteonecrosis in association with cancer chemo - therapy; series of 10 cases. J Oral Pathol Med 34: 120-123, 2005
Bagan J, Blade J, Cozar JM, Constela M, Sanz RG, Veiga FG: Recom - mendations for the prevention, diagnosis, and treatment of the osteonecrosis of the jaw (ONJ) in cancer patients treated with bisphosphonates. Med Oral Patol Oral Cir Bucal 12: 336-340, 2007
Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA: Effects of continuing or stopping aledronate after 5 years of treatment. The fracture intervention trial long-term extension (FLEX). JAMA 296: 2927-2938, 2006
Borgioli A, Viviani C, Duvina M, Brancato L, Spinelli G, Brandi ML, Tonelli P: Bisphposphonate-related osteonecrosis of the jaw: clinical and physiopathological considerations. Therapeutics and Clinical Risk Management 5: 217-227, 2009
Brooks JK, Gilson AJ, Sindler AJ, Ashman SG, Schwartz KG, Nikitakis NG: Osteonecrosis of the jaws associated with use of risedronate: Report of 2 new cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103: 780-786, 2007
Chiandussi S, Biasotto M, Dore F, Cavalli F, Cova MA, Di Lenarda LR: Clinical and diagnostic imaging of bisphosphonate-associated osteonecrosis of the jaws. Dentomaxillofac Radiol 35: 236-243, 2006
Christopoulos P, Papadimopoulos D, Melakopoulos I: Osteonecrosis of the mandible due to co-administration of oral bisphosphonates and corticosteroids. Case report. Hellenic Rheumatology 19(4): 335-339, 2008
David P, Baron R: The vacuolar HI-ATPase: a potential target for drug development in bone diseases. Expert Opin Invest Drugs 4: 725- 739, 1995
Edwards BJ, Hellstein JW, Jacobsen PL, Kaltman S, Mariotti A, Migliorati CA: Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy. J Am Dent Assoc 139(12): 1674-1677, 2008
Ferretti G, Fabi A, Carlini P, Papaldo P, Di Cosimo S: Zoledronic Acid induced circulating level modifications of angiogenic factors, metalloproteinases and proinflammatory cytokines in metastatic breast cancer patients. Oncology 69(1): 35-43, 2005
Gutta R, Louis PJ: Bisphosphonates and osteonecrosis of the jaws: Science and rationale. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104: 186-193, 2007
Hansen T, Kunkel M, Weber A, James Kirckpatrick C: Osteonecrosis of the jaws in patients treated with bisphosphonates- histomorphologic analysis in comparison with infected osteoradionecrosis. J Oral Pathol Med 35: 155-160, 2006
Hewitt C, Farah CS: Bisphposphonate-related osteonecrosis of the jaws: a comprehensive review. J Oral Pathol Med 319-328, 2007
Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PT, Felsenberg D: Bisphposphonate-associated osteonecrosis of the jaw: Report of a task force of the American Society for Bone and Mineral Re - search. J Bone Miner Res 22: 1479-1491, 2007
Laskaris G, Gagari E: Bisphposphonate-related osteonecrosis of the jaws: risk-factors, prevention and treatment. Hellenic Rheuma - tology 19(1): 74-80, 2008 Marx RE: Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxil - lofac Surg 61; 115-117, 2003
Marx RE, Sawatariy Y, Fortin M, Broumand V: Bisphosphonate- indu - ced exposed bone (osteonecrosis/osteopetrosis) of the jaws; Risk factors, recognition, prevention and treatment. J Oral Maxil - lofac Surg 63: 1567-1575, 2005
Marx RE, Cillo JE, Ulloa JJ: Oral bisphosphonate-induced osteonecrosis: Risk-factors, prediction of risk using serum CTX testing, prevention and treatment. J Oral Maxillofac Surg 65:2397-2410, 2007
Migliorati CAα, Casiglia J, Epstein J, Jacobsen PL, Siegel MA, Woo SB: Managing the care of patients with bisphposphonate-associated osteonecrosis. An American Academy of Oral Medicine position paper. JADA 136: 1658-1668, 2005
Migliorati CAβ, Schubert MM, Peterson DE, Seneda LM: Bisphpo - sphonate-associated osteonecrosis of mandibular and maxillary bone. An emerging oral complication of supportive cancer therapy. Cancer 104:83-93, 2005
Migliorati CA, Armonis BN, Nicolatou-Galitis O: Oral osteonecrosis with the use of ibadronate: report of a case and clinical implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106(1): 18-21, 2008
Monkkonen H, Auriola S, Lehenkari P: A new endogenous ATP analog (Apppl) inhibits the mitochondrial adenine nucleotide transocase (ANT) and is responsible for the apoptosis induced by nitrogen-containing bisphosphonates. Br J Pharmacol 147: 437-445, 2006
Nikitakis N, Kamperos G, Sklavounou-Andrikopoulou A: Bisphpo - spho nate-induced osteonecrosis of the jaws; prevention and management. Archives of Hellenic Medicine 26(5): 583-592, 2009
Polymeris AD, Polymeri AA, Papapetrou PD: Bisphosphonates and osteonecrosis of the jaws. Archives of Hellenic Medicine 23(1): 97-98, 2006
Rizzoli R, Burlet N, Cahall D, Delmas PD, Eriksen EF, Felsenberg D: Osteonecrosis of the jaw and bisphosphonate treatment for osteoporosis. Bone 42: 841-847, 2008
Romanos G, Konsolaki E, Hatzimanolis P: Bisphposphonate-induced osteonecrosis of the jaws. Report of 24 cases. Hellenic Stomatological Review 53: 243- 252, 2009
Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL: Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 62: 527-534, 2004
Ruggiero SL, Fantasia J, Carlson E: Bisphosphonate-related osteone - crosis of the jaw: Background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102: 433-441, 2006
Stewart AF: Clinical practice: hypercalcemia associated with cancer N Engl J Med 352:373-379, 2005
Tsetsenekou E, Kalyvas D: New insights into the mechanisms of bisphosphonates action. Hellenic Archives of Oral and Maxillofacial Surgery 3: 157-166, 2010 Wang HL, Weber D, McCauley LK: Effect of long-term oral bisphosphonates on implant wound healing: Literature review and a case report. J Periodontol 78: 584-594, 2007
How to cite this article:
|
View the full-text PDF:
|
| ||